Historically redlined districts tied to racial disparities in delivery rooms

American women living in historically redlined ZIP codes have increased risk for both preterm and periviable births, according to a study published in JAMA Network Open Sept. 30.

Researchers analyzed birth certificate data from nine New York counties from 2005 to 2018. They then matched modern obstetric outcomes with regions classified by the government for mortgage loan servicing based on racially discriminatory criteria from the 1940 Home Owners' Loan Corporation map.  

From 2005 to 2018, there were 64,804 live births among the 15 ZIP codes overlaying historically "redlined" regions.

Six things to know:

1. The lowest overall preterm birth rate prevalence — 217 of 2,873 births, or 7.55 percent — was in the ZIP code historically defined as "best" or "still desirable." 

2. The highest overall preterm birth rate — 427 of 3,449 births, or 12.38 percent — was in the ZIP code historically defined as "hazardous." 

3. These associations with preterm birth remained significant after controlling for poverty levels, educational attainment and parental race. 

4. Increased risks include higher rates of preeclampsia, stillbirth, preterm birth, fetal growth restriction and maternal morbidity and mortality in Black women compared with white women. While disparities were recorded for other racial and ethnic groups, the differences between Black and white people are the most stark and persistent, the authors wrote in a study commentary.

5. These findings suggest that historic discriminatory policies remain associated with poor obstetrical outcomes, and that intergenerational discrimination and disinvestment continue to play a role in modern health disparities.

6. "This is an opportunity to begin to understand how health inequities were and are created and allowed to persist," the study authors wrote. "While we, as clinicians, may not be responsible for these sources of health inequity, it is incumbent on each of us to recognize the systemic racism our patients have experienced and seek out how to reduce the health inequities they incur."

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