• Patrick H Ryan, Antonella Zanobetti, Brent A Coull, Howard Andrews, Leonard B Bacharier, Dakota Bailey, Paloma I Beamer, Jeff Blossom, Cole Brokamp, Soma Datta, Tina Hartert, Gurjit K Khurana Hershey, Daniel J Jackson, Christine C Johnson, Christine Joseph, Jorja Kahn, Nathan Lothrop, Margee Louisias, Heike Luttmann-Gibson, Fernando D Martinez, Eneida Mendonça, Rachel L Miller, Dennis Ownby, Sima Ramratnam, Christine M Seroogy, Cynthia M Visness, Anne L Wright, Edward M Zoratti, James E Gern, and Diane R Gold.
• Cincinnati Children's Hospital Medical Center, Division of Biostatistics and Epidemiology, Cincinnati, Ohio, United States.
• Am. J. Respir. Crit. Care Med. 2024 Jun 13.

RationaleIdentifying the root causes of racial disparities in childhood asthma is critical for health equity.ObjectivesTo determine if the 1930's racist policy of redlining led to present-day disparities in childhood asthma by increasing community-level poverty and decreasing neighborhood socioeconomic position (SEP).MethodsWe categorized census tracts at birth of participants from the Children's Respiratory and Environmental Workgroup birth cohort consortium into A, B, C, or D categories as defined by the Home Owners Loan Corporation (HOLC), with D being the highest perceived risk. Surrogates of present-day neighborhood-level SEP were determined for each tract including the percentage of low-income households, the CDC's social vulnerability index (SVI), and other tract-level variables. We performed causal mediation analysis, which, under the assumption of no unmeasured confounding, estimates the direct and mediated pathways by which redlining may cause asthma disparities through census tract-level mediators adjusting for individual-level covariates.Measurements And Main ResultsOf 4,849 children, the cumulative incidence of asthma through age 11 was 26.6% and 13.2% resided in census tracts with a HOLC grade of D. In mediation analyses, residing in grade D tracts (aOR = 1.03 [95%CI 1.01,1.05]) was significantly associated with childhood asthma, with 79% of this increased risk mediated by percentage of low-income households; results were similar for SVI and other tract-level variables.ConclusionsThe historical structural racist policy of redlining led to present-day asthma disparities in part through decreased neighborhood SEP. Policies aimed at reversing the effects of structural racism should be considered to create more just, equitable, and healthy communities.

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