Historical Neighborhood Redlining and Cardiovascular Risk in Patients With Chronic Kidney Disease

Abstract

Cardiovascular risk; neighborhood; walkability; built environmentThe leading cause of death among individuals with Chronic Kidney Disease (CKD) is Cardiovascular Disease (CVD).Social risk factors, including the effects of neighborhoods and systemic racism, have been as associated with CVD risk.During the 1930s, the United States government-sponsored Home Owners' Loan Corporation (HOLC) implemented a grading system to evaluate neighborhood risk for mortgage applications.1 Neighborhoods rated "A", depicted in green, represented the wealthiest areas, while areas rated "D", depicted in red, represented the poorest neighborhoods and were referred to as "redlined."This practice resulted in residential segregation and has contributed to persistent systemic racism. 1 We have previously demonstrated a link between redlining and increased neighborhood-level cardiometabolic risk, including CVD and CKD, throughout the US. 2 The aim of this study is to investigate the association between redlining and the prevalence and incidence of CVD in a contemporary prospective cohort of patients with CKD.The data that support the findings of this study are available from the corresponding author.Data were obtained from participants that enrolled in the Chronic Renal Insufficiency Cohort in 2003-2008.The study protocol was approved by institutional review boards at the participating institutions.3 All human subjects provided informed consent to participate in the study.Briefly, adults with mild to moderate CKD were recruited from 7 sites and followed prospectively for incident CVD.Events are adjudicated via phone calls and review of medical records.The residential addresses of participants were geocoded into census block groups at study entry and linked to HOLC-graded maps generated from digitized maps.We examined the association of participant neighborhood HOLC grade with prevalent

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