ArticlePaediatric and perinatal epidemiology2023
Remapping racial and ethnic inequities in severe maternal morbidity: The legacy of redlining in California.
Article in Paediatric and perinatal epidemiology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
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Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it, 15 citations in OpenAlex.
- A systematic review of historic neighborhood redlining and contemporary health outcomes.Public health · 2025Pooled it
- Structural Racism, Geographies of Opportunity, and Maternal Health Inequities: A Dynamic Conceptual Framework.Journal of racial and ethnic health disparities · 2026Article
- A Standard Measure of Structural Racism, Do We Have One? Can We Have One? A Narrative Review of Commonly Used Measures and Domains of Use.Journal of racial and ethnic health disparities · 2025Review
- Association of Historical Redlining With Gestational Diabetes Mellitus: The Mediating Role of BMI and Area Deprivation Index.Diabetes care · 2025Article
- Using spatial Bayesian models to estimate associations between structural racial discrimination and disparities in severe maternal morbidity.Social science & medicine (1982) · 2025Article
- Historical Redlining, Contemporary Gentrification, and Severe Maternal Morbidity in California, 2005-2018.JAMA network open · 2024Article
- Associations of Historical Redlining With BMI and Waist Circumference in Coronary Artery Risk Development in Young Adults.AJPM focus · 2024Article
- Association Between Historical Redlining and Access to High-Volume Hospitals Among Patients Undergoing Complex Cancer Surgery in California.Annals of surgical oncology · 2024Article
- EV-miRNA associated with environmental air pollution exposures in the MADRES cohort.Environmental epigenetics · 2024Article
- Neighborhood gentrification, displacement, and severe maternal morbidity in California.Social science & medicine (1982) · 2023Article
- Managing Pregnancy and Nursing Affecting African American Women with Inflammatory Bowel Disease: Clinical Outcomes and Parenthood.Medical research archives · 2023Article
Corrections and comments
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Authors and funding
8 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundHistorical mortgage redlining, a racially discriminatory policy designed to uphold structural racism, may have played a role in producing the persistently elevated rate of severe maternal morbidity (SMM) among racialised birthing people.
objectiveThis study examined associations between Home-Owner Loan Corporation (HOLC) redlining grades and SMM in a racially and ethnically diverse birth cohort in California.
methodsWe leveraged a population-based cohort of all live hospital births at ≥20 weeks of gestation between 1997 and 2017 in California. SMM was defined as having one of 21 procedures and diagnoses, per an index developed by Centers for Disease Control and Prevention. We characterised census tract-level redlining using HOLC's security maps for eight California cities. We assessed bivariate associations between HOLC grades and participant characteristics. Race and ethnicity-stratified mixed effects logistic regression models assessed the risk of SMM associated with HOLC grades within non-Hispanic Black, Asian/Pacific Islander, American Indian/Alaskan Native and Hispanic groups, adjusting for sociodemographic information, pregnancy-related factors, co-morbidities and neighbourhood deprivation index.
resultsThe study sample included 2,020,194 births, with 24,579 cases of SMM (1.2%). Living in a census tract that was graded as "Hazardous," compared to census tracts graded "Best" and "Still Desirable," was associated with 1.15 (95% confidence interval [CI] 1.03, 1.29) and 1.17 (95% CI 1.09, 1.25) times the risk of SMM among Black and Hispanic birthing people, respectively, independent of sociodemographic factors. These associations persisted after adjusting for pregnancy-related factors and neighbourhood deprivation index.
conclusionsHistorical redlining, a tool of structural racism that influenced the trajectory of neighbourhood social and material conditions, is associated with increased risk of experiencing SMM among Black and Hispanic birthing people in California. These findings demonstrate that addressing the enduring impact of macro-level and systemic mechanisms that uphold structural racism is a vital step in achieving racial and ethnic equity in birthing people's health.
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