Description:
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<jats:bold>Introduction:</jats:bold>
Racial discrimination has existed for centuries in the US and contributes to disparities in stroke and stroke outcomes. Measures of structural racism have been used to quantify these disparities. Our objective was to determine if the efficacy of a skills-based intervention on blood pressure reduction in a cohort of mild/moderate strokes varied by historic redlining, the US Federal government’s sanctioned discrimination in mortgage risk assessment.
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<jats:bold>Methods:</jats:bold>
The Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) intervention randomized 552 participants to a skills-based intervention or usual care. Participants addresses were geocoded and linked to federally sponsored Home Owners’ Loan Corporation (HOLC) color-coded maps from the 1930s. Participants residing in graded locations (n=279) were given weighted historic redlining scores (HRS) calculated using the proportion of 1930s HOLC residential security grades contained within 2010 census tract boundaries and a discrimination score based current lending practices. The change in systolic blood pressure was modeled linearly with generalized estimating equations used to account for clustering by site.
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<jats:bold>Results:</jats:bold>
Participants were 34% Hispanic, 31% non-Hispanic Black, 28% non-Hispanic white, and 7% other race. The intervention was most efficacious in areas of persistent (Δ=6.05 mmHg reduction; p=0.003) and declining discrimination (Δ=11.08 mmHg reduction; p=0.007) versus usual care. In areas that were gentrifying, the intervention was least efficacious (Δ=7.33mmHg increase; p=0.022) and minimal in areas of no discrimination (Δ=0.054 mmHg reduction; p=0.903).
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<jats:bold>Conclusions:</jats:bold>
Historic redlining practices are a form of structural racism that established geographic systems of disadvantage. The efficacy of interventions are impacted by underlying systems of disadvantage such that contextual factors beyond race must be considered when designing trials.
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