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Kidney Week

Abstract: SA-PO033

High Prevalence of Diabetes and Kidney Disease in Areas of Chicago Historically Subjected to Housing Discrimination Laws (Redlining)

Session Information

Category: Diversity and Equity in Kidney Health

  • 900 Diversity and Equity in Kidney Health

Authors

  • Bragg-Gresham, Jennifer L., University of Michigan Medical School, Ann Arbor, Michigan, United States
  • Fraunhofer, Linda, Laboratory Corporation of America Holdings, Burlington, North Carolina, United States
  • Licon, Ana Laura, University of Michigan Medical School, Ann Arbor, Michigan, United States
  • Veinot, Tiffany C., University of Michigan School of Information, Ann Arbor, Michigan, United States
  • Heung, Michael, University of Michigan Medical School, Ann Arbor, Michigan, United States
  • Ennis, Jennifer L., Laboratory Corporation of America Holdings, Burlington, North Carolina, United States
  • Saran, Rajiv, University of Michigan Medical School, Ann Arbor, Michigan, United States
Background

In 1940, Home Owners' Loan Corporation (HOLC) produced a map of Chicago, IL as a safety investment guide for mortgage lenders. The areas labeled “hazardous” reinforced racial residential segregation with lasting patterns of inequality continuing today. We hypothesize that individuals residing in these “less desirable” neighborhoods continue to face numerous challenges contributing to the development and progression of kidney disease, including a higher prevalence of diabetes.

Methods

Using 2022 Labcorp data from ~400K laboratory tests from individuals residing in previously mapped HOLC districts, we spatially joined results to each category (A: Best, B: Desirable, C: Declining, and D: Hazardous). We examined results for both kidney disease indicators (eGFR <60 ml/min/1.73m2 and urine albumin to creating ratio >30 mg/g), as well as HbA1c to examine potential diabetes (HbA1c ≥6.5%) and prediabetes (HbA1c of 5.7%-6.4%). The odds of kidney disease, diabetes, and prediabetes by HOLC grade were assessed by logistic regression, adjusting for age and sex.

Results

Individuals who live in HOLC-A neighborhoods (<1%) were older with a higher proportion of males than the other HOLC categories, which were more similar in demographic characteristics (53 years vs. 48 years and 42.3% vs. 40.8% male). Mean HbA1c was higher in HOLC grades B-D vs A, with correspondingly higher rates of potential diabetes and prediabetes. After adjusting for differences in age and sex, the odds of all three outcomes were significantly higher in HOLC grades B-D, compared to HOLC-A (p<0.0001).

Conclusion

Significant associations were seen between historically redlined areas and the odds of diabetes, prediabetes, and kidney disease. It is imperative to both understand the mechanisms underlying these observations and to develop place/person-centered intervention programs to mitigate the effects of these disparities.

Funding

  • Other U.S. Government Support