209-OR: Direct and Indirect Effects of Redlining on Diabetes Prevalence via Food Access

Structural racism is known to influence diabetes outcomes; however, there is limited understanding of potential pathways for the relationship. Given the importance of access to healthy food for adults at risk for diabetes, this study investigated food access as a possible pathway between structural racism and diabetes prevalence at a census tract level. A national dataset of 11,457 census tracts across 201 counties, within 38 states was used for the analysis. Prevalence of diabetes in each census tract was based on CDC PLACES data. Structural racism was defined as historic residential redlining using Home Owners’ Loan Corporation (HOLC) residential security maps from the Mapping Inequality project (higher scores indicate more redlining). Food access was defined using the modified retail food environment index (mRFEI) calculated for each census tract as the number of healthy food retailers divided by the number of both healthy and less healthy food retailers (higher mRFEI scores indicate better food access). Direct and indirect relationships between redlining and diabetes prevalence via food access was investigated using structural equation modeling run in Stata v17, controlling for population of each census tract. Mean prevalence of diabetes was 11.8. Redlining (0.22, p<0.001) and lower food access (-0.11, p<0.001) were directly associated with higher prevalence of diabetes. Redlining was indirectly associated with diabetes via food access (-0.10, p<0.001). Based on these findings, structural racism is associated with higher diabetes prevalence via decreased food access at a census tract level. Interventions to improve access to healthy food options at the community level may help address the impact of structural racism on the health of individuals, particularly those at risk for diabetes living in historically redlined neighborhoods.