95 - Differential impacts of historical redlining and contemporary mortgage discrimination on birth outcomes in Chicago, IL

Publication Number: 3091.95

Christina Duhig, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Hannah Matzke, Chicago Department of Public Health, Chicago, IL, United States; Mech Frazier, Northwestern University, Chicago, IL, United States; Nikhil G. Prachand, Chicago Department of Pubic Health, Chicago, IL, United States; James Collins, Ann & Robert H. Lurie Children's Hospital of Chicago, chicago, IL, United States

Background: Historical redlining is a risk factor for preterm birth risk in the context of economic inequities and disparate neighborhood investment. Contemporary mortgage discrimination has evolved with a growing body of literature demonstrating its adverse effects on birth outcomes among minoritized populations. The complexity of shifting neighborhood demographics requires an in-depth analysis into the relationship of residing in both a historically redlined and contemporary mortgage discriminated neighborhood and birth outcomes.

Objective: Our study seeks to describe the effects of living in a historical redlined and contemporary mortgage discriminated neighborhood and birth outcomes in Chicago, IL.

Design/Methods: Home Mortgage Disclosure Act data (HMDA) were appended to vital records of births in Chicago, IL from 2010-2022. Chicago community areas (n=77) were categorized into historical redlining grades (A or B, C, and D) based on Home Owners Loan Corporation (HOLC) area apportionment overlap at the census tract level using ArcGIS Pro version 3.0 (Esri, Inc.). Based on odds ratios of loans denials for African American applicants (compared to non-Hispanic White), Chicago community areas were defined as contemporary mortgage discriminated or non-mortgage discriminated neighborhoods. Rates of preterm birth (PTB) and small for gestational age (SGA) were determined. Multivariable logistic regression models were calculated using the 25th percentile historical redlining score (HRS) and contemporary mortgage discrimination OR cutoff of 1.4.

Results: In contemporary non-mortgage discriminated neighborhoods, the proportion of non-Hispanic Black women exceeded that of neighborhoods with mortgage discrimination: 91.7% 24.1%. There was no significant difference in PTB or SGA rates based on residence in historically redlined neighborhoods. There was a significant association between residence in a contemporary mortgage discriminated neighborhood and PTB and SGA (Table 2). Importantly, subgroup analysis showed a protective association of residence in contemporary mortgage discriminated neighborhoods that dissipated for non-Hispanic Black women (Table 3).

Conclusion(s): Current patterns of mortgage discrimination, rather than historical redlining, are more closely linked to present-day birth outcomes in Chicago, IL. Although contemporary mortgage discrimination may indicate benefits related to neighborhood investment and infrastructure, these protective effects on birth outcomes are offset by the contextual effects of structural racism for minoritized populations.

Table 1. Distribution of maternal characteristics by historical redlining and contemporary mortgage discrimination; CDPH Vital Records 2010-2022


Table 2. PTB and SGA rates according to residence in a contemporary mortgage discriminated neighborhood, Chicago Vital Records 2010-2022.
*Controlling for maternal age, education, marital status, parity, prenatal care, BMI, smoking, race/ethnicity

Table 3. Subgroup analysis of PTB and SGA rates according to residence in a contemporary mortgage discriminated neighborhood, Chicago Vital Records 2010-2022.
*Controlling for maternal age, education, marital status, parity, prenatal care, BMI, smoking, race/ethnicity