Impacts of Racial Disparities in Mortgage Lending Practices on Obesity - Limited access to food and physical activity (PA) resources, poor social and economic neighborhood conditions have been linked to low diet quality, physical inactivity, and elevated body mass index (BMI). Yet, mixed findings may be due to gaps in understanding (1) the root causes of unequal allocation of neighborhood resources, and (2) the paths by which neighborhood conditions influence obesity. Housing policies have received little attention in obesity research and yet this may be critical to addressing the epidemic. A key example is historical ‘redlining,’ where, during the 1930s, areas throughout the United States were designated as “high risk” investments based on the neighborhood’s racial composition. Poverty and racial residential patterns in redlined areas persist. Disparities in housing practices continue and may increase obesity disparities via exposure to obesogenic environments. This project is designed to identify specific, modifiable mediating pathways through which historical and current mortgage lending disparities operate on cardiometabolic health. Although healthcare systems cannot directly alter lending practices, identifying which neighborhood conditions mediate relationships between disinvestment and obesity (e.g., dietary behaviors) will reveal where clinically integrated strategies (e.g., Food as Medicine) can interrupt these pathways and reduce cardiometabolic risk in disadvantaged populations. We seek to estimate longitudinal paths from historical and current racial disparities in mortgage lending to BMI using the Coronary Artery Risk Development in Young Adults Study (CARDIA), a longitudinal cohort of 5,115 white and Black adults aged 18–30 years residing in four cities with redlining histories: Birmingham, AL, Oakland, CA, Chicago, IL, and Minneapolis, MN. We will link historic redlining maps and two indices of place- and race-based disparities in mortgage lending to CARDIA participants’ residential locations across 30 years. The project specific aims are to: 1) Determine whether historically redlined neighborhoods have higher levels of obesogenic neighborhood conditions and resident BMI through dietary behaviors and PA than non-redlined neighborhoods; 2) Estimate longitudinal paths between changes in historically redlined neighborhoods and BMI through changes in obesogenic neighborhood conditions, dietary behaviors, and PA; and 3) Estimate longitudinal paths between rates of current place- and race-based disparities in mortgage lending and changes in BMI through changes in obesogenic neighborhood conditions, dietary behaviors, and PA. We will build a structural equation model to estimate these longitudinal paths from residing in historically redlined and currently disinvested areas to BMI changes through dynamic neighborhood conditions, homeownership, PA, and dietary behaviors. The results will identify the specific neighborhood-level and behavioral mediators through which lending practices deprive neighborhoods of resources and influence cardiometabolic health, thus generating an empirical roadmap for where healthcare-based interventions can most efficiently be tested, scaled, and implemented to reduce obesity disparities. Because redlining exposure and contemporary mortgage lending disparities are correlated with numerous individual-, family-, and community-level factors, the longitudinal analyses employ a causal inference framework that leverages CARDIA’s repeated measures design with temporal ordering—including time-varying covariate adjustment and within-person change modeling—to isolate and estimate pathways. Sensitivity analyses will assess residual confounding and support rigorous, reproducible interpretation of the mediated effects.
