Direct and Indirect Effects of Historic Residential Redlining on Prevalence of Cardiometabolic Diseases via Food Access

OBJECTIVE: This study investigated food access as a potential pathway between structural racism and the prevalence of cardiometabolic disease. METHODS: A total of 11,457 census tracts across 201 counties, within 38 states, were combined for a final analytic sample. Direct and indirect relationships between redlining and each cardiometabolic disease via food access were investigated using structural equation modeling run in Stata v17, controlling for the population of each census tract. RESULTS: Mean prevalence of diabetes was 11.8%, high blood pressure 31.9%, coronary heart disease 6.0%, and obesity 31.8%. Redlining (0.22, p < 0.001) and lower food access (-0.11, p < 0.001) were directly associated with higher prevalence of diabetes. Redlining (0.10, p < 0.001) and lower food access (-0.10, p < 0.001) were directly associated with higher prevalence of high blood pressure. Redlining (0.12, p < 0.001) and lower food access (-0.04, p < 0.001) were directly associated with higher prevalence of coronary heart disease. Redlining (0.18, p < 0.001) and lower food access (-0.12, p < 0.001) were directly associated with higher prevalence of obesity. Redlining was also significantly indirectly associated with each condition via food access. CONCLUSIONS: Structural racism was associated with higher cardiometabolic disease prevalence via decreased food access. Interventions to improve access to healthy food at the community level may be needed to address the impact of structural racism on health.