Does time heal all wounds? Examining the lasting impact of historic redlining on contemporary racial disparities in allostatic load in Baltimore, Maryland

OBJECTIVE: To examine associations between historical residential redlining, a form of institutional racism, and contemporary allostatic load (AL), an indicator of physiologic stress, examine differences by race, and whether associations are mediated by neighborhood deprivation. METHODS: We used data from Wave 4 (2013-2017) of the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study in Baltimore, MD, Home Owners Loan Corporation (HOLC) scores, and data from the American Community Survey (ACS). We conducted a multilevel analysis, controlling for individual demographic and behavioral characteristics. RESULTS: Compared to blue- and greenlined neighborhoods, living in a yellowlined neighborhood was positively associated with allostatic load (p < 0.05). We report a significant negative interaction between living in a yellowlined area and race (β = -0.62, p = 0.00), with African American residents showing greater reductions in allostatic load compared with whites. We also found evidence of a moderated mediation, with the indirect effect of living in a yellowlined area on AL through NDI varying by race. CONCLUSIONS: Contemporary residents of historically yellowlined, but not redlined, neighborhoods experienced heightened physiological deterioration. The strength of this association differed by race, and was substantially explained by the contemporary neighborhood deprivation index only for African Americans in yellowlined areas. Addressing health disparities requires attention to the long-lasting impacts of historical practices of institutional racism on contemporary health outcomes.