The Association between Redlining, Visual Impairment and Blindness

Abstract

Purpose : Redlining, a discriminatory practice in the 1930s to 1960s to categorize geographic areas based on investment risk, has negatively impacted communities and individuals. This practice has largely impacted residents of racial and ethnic minority groups and was a form of residential segregation. We hypothesize that neighborhoods with worse redlining scores are associated with visual impairment and blindness (VIB), defined as higher rates of self-reporting blindness or having serious difficulty seeing even when wearing glasses.

Methods : Census tract-level data were obtained from the American Community Survey, including the percent of respondents by tract who had VIB, sex, race, median age, state, and population size. Average redlining scores per census tract (CT) were obtained from OpenICPSR, with scores ranging from 1 to 4 (worst). CTs with missing data or margins of error >15% were excluded. Logistic regression was used to model the effect of redlining on the probability of a CT having a rate of VIB greater than the national average (>2.51%). Results are presented with odds ratios (OR) and 95% confidence intervals (CI). Linear regression was used to estimate the effect of redlining on the logarithm of average VIB. Results are presented with estimates (exponentiated for interpretation on a percentage scale) and 95% CIs.

Results : A total of 12,888 CTs in the US had redlining scores. Of these, 12,227 had complete data meeting inclusion criteria. The average percentage of residents with VIB across our CTs was 2.51% (standard deviation, SD=1.82), and 41% of these CTs had rates of VIB above the national average. The mean redlining score for these tracts was 2.94 (SD=0.78). Logistic regression found worse redlining scores were associated with significantly increased odds of VIB above the national average (OR:1.09; 95% CI:1.08-1.10; p<0.001), after controlling for aggregate measures of age, sex, race, state, and CT population. Similarly, linear regression found that a 1 unit increase in average redlining score was associated with an increase of 10.77% in the percentage of VIB (95% CI: 9.70% -11.85%; p<0.001).

Conclusions : Historical residential segregation through redlining was found to be associated with higher proportions of people living with VIB in these neighborhoods today. This study can aid in the understanding of how geographic area could impact VIB outcomes to inform public health planning and the delivery of eye care.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.