OBJECTIVE We investigated direct and indirect relationships between historic redlining and prevalence of diabetes in a U.S. national sample. RESEARCH DESIGN AND METHODS Using a previously validated conceptual model, we hypothesized pathways between structural racism and prevalence of diabetes via discrimination, incarceration, poverty, substance use, housing, education, unemployment, and food access. We combined census tract–level data, including diabetes prevalence from the Centers for Disease Control and Prevention PLACES 2019 database, redlining using historic Home Owners’ Loan Corporation (HOLC) maps from the Mapping Inequality project, and census data from the Opportunity Insights database. HOLC grade (a score between 1 [best] and 4 [redlined]) for each census tract was based on overlap with historically HOLC-graded areas. The final analytic sample consisted of 11,375 U.S. census tracts. Structural equation modeling was used to investigate direct and indirect relationships adjusting for the 2010 population. RESULTS Redlining was directly associated with higher crude prevalence of diabetes within a census tract (r = 0.01; P = 0.008) after adjusting for the 2010 population (χ2(54) = 69,900.95; P < 0.001; root mean square error of approximation = 0; comparative fit index = 1). Redlining was indirectly associated with diabetes prevalence via incarceration (r = 0.06; P < 0.001), poverty (r = −0.10; P < 0.001), discrimination (r = 0.14; P < 0.001); substance use (measured by binge drinking: r = −0.65, P < 0.001; and smoking: r = 0.35, P < 0.001), housing (r = 0.06; P < 0.001), education (r = −0.17; P < 0.001), unemployment (r = −0.17; P < 0.001), and food access (r = 0.14; P < 0.001) after adjusting for the 2010 population. CONCLUSIONS Redlining has significant direct and indirect relationships with diabetes prevalence. Incarceration, poverty, discrimination, substance use, housing, education, unemployment, and food access may be possible targets for interventions aiming to mitigate the impact of structural racism on diabetes.

中文翻译：

---

结构性种族主义对美国成年人全国代表性样本糖尿病患病率的历史红线和影响

目的 我们在美国全国样本中调查了历史红线与糖尿病患病率之间的直接和间接关系。研究设计和方法使用先前验证的概念模型，我们假设结构性种族主义与糖尿病患病率之间通过歧视、监禁、贫困、药物滥用、住房、教育、失业和食物获取之间的路径。我们结合了人口普查区域层面的数据，包括来自疾病控制和预防中心 PLACES 2019 数据库的糖尿病患病率、使用来自映射不平等项目的历史性房主贷款公司 (HOLC) 地图进行红线标注，以及来自 Opportunity Insights 数据库的人口普查数据。每个人口普查区域的 HOLC 等级（分数介于 1 [最佳] 和 4 [红线] 之间）基于与历史 HOLC 分级区域的重叠。最终分析样本包括 11,375 个美国人口普查区。使用结构方程模型来研究针对 2010 年人口进行调整的直接和间接关系。结果 对 2010 年人口进行调整后，红线与人口普查区内较高的糖尿病粗患病率直接相关 (r = 0.01；P = 0.008) (χ2(54) = 69,900.95；P < 0.001；近似均方根误差 = 0；比较适合指数 = 1)。红线通过监禁（r = 0.06；P < 0.001）、贫困（r = -0.10；P < 0.001）、歧视（r = 0.14；P < 0.001）和糖尿病患病率间接相关。物质使用（通过酗酒衡量：r = -0.65，P < 0.001；吸烟：r = 0.35，P < 0.001）、住房（r = 0.06；P < 0.001）、教育（r = -0.17；P < 0.001）对 2010 年人口进行调整后，P < 0.001）、失业率（r = -0.17；P < 0.001）和粮食获取（r = 0.14；P < 0.001）。结论红线与糖尿病患病率有显着的直接和间接关系。监禁、贫困、歧视、药物滥用、住房、教育、失业和食物获取可能是旨在减轻结构性种族主义对糖尿病影响的干预措施的目标。