Association of historical redlining and present-day racialised economic segregation with health-care utilisation among individuals with rheumatic conditions in Massachusetts and surrounding areas of the USA: a retrospective cohort study
Authors' conclusion
Historical redlining could be a structural determinant of inequities in present-day health-care utilisation patterns.
Study context
- Population
- Adults (≥18 years) with ≥2 ICD codes for a rheumatic condition, receiving care at Mass General Brigham rheumatology practices, Massachusetts and surrounding areas, 2000–2023median age 63
- Participants
- 5,597 adults
- Exposure
- Historical redlining and present-day racialised economic segregation
- Home Owners' Loan Corporation (HOLC) Dn = 1,295
- ICE quintile 1n = 1,780
- Outcome
- Health-care utilisation (missed appointments, ED visits)
Methodological detailsmultihospital, multilevel, multinomial logistic regression, adjusted for demographics, insurance, and comorbidities, People with lived experience of a rheumatic condition were not involved in the design or implementation
- Multihospital
- Multilevel, multinomial logistic regression
- Adjusted for demographics, insurance, and comorbidities
- People with lived experience of a rheumatic condition were not involved in the design or implementation
Main finding
As reported in the abstract
Health-care utilisation
Odds ratio (95% CI)P value
HOLC Dvs HOLC A≥4 missed appointments
1.78(1.21–2.61)
P = 0.0033HOLC Dvs HOLC A≥3 ED visits
2.69(1.48–4.89)
P = 0.0011ICE quintile 1vs ICE quintile 5≥4 missed appointments
2.11(1.65–2.71)
P < 0.0001ICE quintile 1vs ICE quintile 5≥3 ED visits
2.97(2.02–4.35)
P < 0.0001Observational data: associations, not effects.
Original publication
Association of historical redlining and present-day racialised economic segregation with health-care utilisation among individuals with rheumatic conditions in Massachusetts and surrounding areas of the USA: a retrospective cohort study. Lancet Rheumatol. Published 19 November 2024. doi:10.
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