• Ayesha Dholakia, Kendall J Burdick, Catherine Kreatsoulas, Michael C Monuteaux, Jennifer Tsai, S V Subramanian, and Eric W Fleegler.
• Department of Pediatrics, Boston Children's Hospital, and Department of Pediatrics, Boston Medical Center, Boston, Massachusetts (A.D., K.J.B.).
• Ann. Intern. Med. 2024 Apr 23.

BackgroundRedlining began in the 1930s with the Home Owners' Loan Corporation (HOLC); this discriminatory practice limited mortgage availability and reinforced concentrated poverty that still exists today. It is important to understand the potential health implications of this federally sanctioned segregation.ObjectiveTo examine the relationship between historical redlining policies and present-day nonsuicide firearm fatalities.DesignMaps from the HOLC were overlaid with incidence of nonsuicide firearm fatalities from 2014 to 2022. A multilevel negative binomial regression model tested the association between modern-day firearm fatalities and HOLC historical grading (A ["best"] to D ["hazardous"]), controlling for year, HOLC area-level demographics, and state-level factors as fixed effects and a random intercept for city. Incidence rates (IRs) per 100 000 persons, incidence rate ratios (IRRs), and adjusted IRRs (aIRRs) for each HOLC grade were estimated using A-rated areas as the reference.Setting202 cities with areas graded by the HOLC in the 1930s.ParticipantsPopulation of the 8597 areas assessed by the HOLC.MeasurementsNonsuicide firearm fatalities.ResultsFrom 2014 to 2022, a total of 41 428 nonsuicide firearm fatalities occurred in HOLC-graded areas. The firearm fatality rate increased as the HOLC grade progressed from A to D. In A-graded areas, the IR was 3.78 (95% CI, 3.52 to 4.05) per 100 000 persons per year. In B-graded areas, the IR, IRR, and aIRR relative to A areas were 7.43 (CI, 7.24 to 7.62) per 100 000 persons per year, 2.12 (CI, 1.94 to 2.32), and 1.42 (CI, 1.30 to 1.54), respectively. In C-graded areas, these values were 11.24 (CI, 11.08 to 11.40) per 100 000 persons per year, 3.78 (CI, 3.47 to 4.12), and 1.90 (CI, 1.75 to 2.07), respectively. In D-graded areas, these values were 16.26 (CI, 16.01 to 16.52) per 100 000 persons per year, 5.51 (CI, 5.05 to 6.02), and 2.07 (CI, 1.90 to 2.25), respectively.LimitationThe Gun Violence Archive relies on media coverage and police reports.ConclusionDiscriminatory redlining policies from 80 years ago are associated with nonsuicide firearm fatalities today.Primary Funding SourceFred Lovejoy Housestaff Research and Education Fund.

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