Structural Racism and Pedestrian Safety: Measuring the Association Between Historical Redlining and Contemporary Pedestrian Fatalities Across the United States, 2010‒2019.

<strong>Objectives.</strong> To examine the association between historical redlining and contemporary pedestrian fatalities across the United States. <strong>Methods.</strong> We analyzed 2010-2019 traffic fatality data, obtained from the Fatality Analysis Reporting System, for all US pedestrian fatalities linked by location of crash to 1930s Home Owners' Loan Corporation (HOLC) grades and current sociodemographic factors at the census tract level. We applied generalized estimating equation models to assess the relationship between the count of pedestrian fatalities and redlining. <strong>Results.</strong> In an adjusted multivariable analysis, tracts graded D ("Hazardous") had a 2.60 (95% confidence interval&thinsp;=&thinsp;2.26, 2.99) incidence rate ratio (per residential population) of pedestrian fatalities compared with tracts graded A ("Best"). We found a significant dose‒response relationship: as grades worsened from A to D, rates of pedestrian fatalities increased. <strong>Conclusions.</strong> Historical redlining policy, initiated in the 1930s, has an impact on present-day transportation inequities in the United States. <strong>Public Health Implications.</strong> To reduce transportation inequities, understanding how structurally racist policies, past and present, have an impact on community-level investments in transportation and health is crucial.