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. Author manuscript; available in PMC: 2026 Sep 30.
Published in final edited form as: Soc Sci Med. 2026 Aug 7;406:119686. doi: 10.1016/j.socscimed.2026.119686

Lasting Effects of Redlining: The Association of Historical Redlining and Cognitive Function in Older Black Adults

Brittney S Lange-Maia 1,2, Melissa Lamar 1,3, Jason LaBrosse 1, Ana W Capuano 4, V Eloesa McSorley 1, Francine Grodstein 1,5, Bryan D James 1,5, Lisa L Barnes 1,6
PMCID: PMC13623191  NIHMSID: NIHMS2209681  PMID: 42574867

Abstract

Background:

Residing in a formerly redlined community is often associated with worse health. Few studies have studied redlining and late-life cognition; none have examined multiple cognitive domains.

Methods:

Black older adults (N=676, mean baseline age 74.1 [SD: 6.5] years, 78.2% female) from two cohorts in n Chicago, IL completed annual cognitive assessments of episodic, semantic, and working memory, perceptual speed, and visuospatial ability. Baseline geocoded addresses were matched to historic Home Owners’ Loan Corporation grades (“best,” “still desirable,” “definitely declining,” and “redlined” [first two combined in analyses]). Grades served as place-based proxies for the culmination of decades of policies that heavily impacted redlined communities. Linear mixed-effects models tested associations between grade and change in global and domain-specific cognition, adjusting for age, sex, and years of education.

Results:

Compared to those in communities graded as “best/still desirable,” participants in redlined communities had lower initial global cognition (β=0.14, SE=0.05, p=0.01), though there were no differences for those in “definitely declining” communities, or differences in the rate of longitudinal change. For cognitive domains, those in redlined communities had lower initial episodic and working memory (β=−0.13, SE=0.07, p=0.04 and β=−0.17, SE=0.08, p=0.03, respectively), but slower decline in semantic memory (β=0.03, SE=0.01, p=0.04) compared to those in “best/still desirable” communities. Results remained consistent when considering potential mediators related to health status, present-day community resources characteristics, and spatial correlations.

Conclusions:

Residing in a historically redlined community is associated with cognition in older Black adults, indicating importance of historical community context, though these results are nuanced.

INTRODUCTION

Social epidemiology has long demonstrated links between the contextual environment and health, including physical and mental health. (Aneshensel, 1992; Dalgard & Tambs, 1997; Diez-Roux et al., 1997; Goldsmith et al., 1986). For example, a robust body of research has shown that poor neighborhood conditions and residential segregation are detrimental to a range of poor health outcomes (Barr, Diez-Roux, Knirsch, & Pablos-Méndez, 2001; Jackson, Anderson, Johnson, & Sorlie, 2000; Yen & Syme, 1999). However, with research on older adults, individual-level characteristics and risk factors (e.g. health behaviors, disease risk factors, and individual socioeconomic status) have been the predominate focus. The influence of studies from public health, sociology, and demography has resulted in a shift whereby a growing number of studies now examine community-level characteristics (e.g. availability of community resources, built environment, segregation) and their association with cognition, cognitive decline, and risk of dementia (X. Chen, Lee, & Huang, 2022; Jang et al., 2021; Kovalchik, Slaughter, Miles, Friedman, & Shih, 2015). In these studies, community-level economic hardship is generally associated with worse cognitive function, while community affluence is associated with better cognitive function, primarily due to the greater abundance of social and institutional resources that promote brain health (Clarke et al., 2012; Lang et al., 2008; Wu, Prina, & Brayne, 2015). However, these upstream factors like community-level resources and socioeconomic factors are not randomly patterned. Their distribution is impacted by policies, legal forces, and societal factors—including those related to systemic racism—that contribute to contemporary community characteristics and segregation. There have been several theories advanced to explain how community characteristics and residential segregation lead to economic and political disenfranchisement of certain communities, and either directly or indirectly impact health. In this paper, we use an ecosocial framework to guide our investigation of how community context may influence an important cognitive aging outcome, cognitive decline in older Black adults. The ecosocial framework focuses on how health and disease patterns are impacted by the “multilevel spatiotemporal processes of embodying (in)justice, across the life course and historical generations, as shaped by the political economy and political ecology of the societies in which people live” (Krieger, 2021, p. 16).

Determining how a web of policies, legal forces, and societal factors may promote or harm cognition in late life is challenging and likely involves a wide variety of variables. Using historical redlining as a proxy of systemic racism may be useful for assessing relationships between community context and cognition. Redlining, though not originally named as such until later, can be used as a measure of institutional housing discrimination, as it involved the practice of categorizing perceived lending risk of a neighborhood, largely based upon explicitly racially biased ideas (Nelson, Winling, Marciano, & Connolly, 2021). The Residential Security Maps developed by the Home Owners Lending Corporation (HOLC) were created in the late 1930s and graded communities based upon perceived lending risk into one of four categories denoted on color coded maps: A “best”–green, B “still desirable”–blue, C “definitely declining”–yellow, and D “hazardous”–red. While the HOLC maps did not initiate redlining (Michney, 2022) - and HOLC lending did not strictly mirror these risk grades since the maps were created after the mandated task of refinancing homes in foreclosure (Greer, 2013) - the HOLC practices in reselling foreclosed properties did contribute to racial segregation (Hillier, 2003). Ultimately, the spatial inequalities captured at the time of the maps’ creation largely persist today (Logan, Kye, Carlson, Minca, & Schleith, 2023). Areas that had lower ratings—particularly those that were graded low because of having a large number of Black residents—continued to have greater racial segregation, worse housing outcomes, and worse socioeconomic outcomes over time, even until now (Aaronson, Faber, Hartley, Mazumder, & Sharkey, 2021; Aaronson, Hartley, & Mazumder, 2021; Gibbons, 2025; R. B. Smith & Painter, 2025).

The body of research showing that residing in a historically redlined community is related to worse health at the community and individual levels has been rapidly growing since the release of the HOLC maps by the University of Richmond’s Mapping Inequality project (Lee et al., 2022; Nelson et al., 2021; Swope, Hernández, & Cushing, 2022). Ecologic studies have shown that residing in a historically redlined community is associated with higher population-level risks of preterm birth (Nancy Krieger et al., 2020), cancer rates (N. Krieger et al., 2020; Wright, Waterman, Testa, Chen, & Krieger, 2022), COVID-19 exposure (M. Li & Yuan, 2022), heat-related emergency department visits (D. Li, Newman, Wilson, Zhang, & Brown, 2022), and emergency department visits due to asthma (A. Nardone et al., 2020). Individual-level associations with residing in a historically redlined community and worse health have also been noted, ranging from worse inpatient hospitalization outcomes (Diaz et al., 2021), cardiovascular health (Mujahid, Gao, Tabb, Morris, & Lewis, 2021) to adverse birth outcomes (A. L. Nardone et al., 2020). Few studies have focused specifically on potential associations between redlining and late-life health, and among these few studies, directions of associations have been mixed and appear to differ by race. For example, one study of Medicare beneficiaries showed a higher risk of heart failure among Black patients currently living in historically redlined communities, but this relationship was not evident among white patients (Mentias et al., 2023). To our knowledge, only one study has examined associations between redlining and late-life cognition, and results were nuanced. In that analysis conducted in the Health and Retirement Study (HRS) of adults age 50+ years, the authors found that among the full sample, living in a historically redlined community was associated with lower initial cognition, but not rate of change in cognition (Fisk, Ailshire, & Walsemann, 2025). However, among older Black adults in that sample, living in a redlined community was associated with slower cognitive decline, indicating potential race-specific effects of redlining–albeit in an unexpected direction. This study also utilized the Telephone Instrument for Cognitive Status, a brief measure of global cognition, potentially limiting the ability to investigate associations in specific cognitive domains.

Potential mechanisms linking residence in historically redlined neighborhoods to higher rates of poor health outcomes may stem from factors related to community disinvestment that have persisted since the HOLC maps were created. These likely include lack of access to medical care, scant health-promoting community-level resources (e.g. social services, greenspace, walkable environments, and grocery stores), higher concentration of environmental risk factors like pollution, and lack of other aspects of the built environment that are important for well-being (e.g. well-resourced schools, transportation, quality housing) and contribute to chronic stress and ultimately worse health outcomes (Andersen, 1995; Freifeld et al., 2024; Jacoby, Dong, Beard, Wiebe, & Morrison, 2018; Mujahid et al., 2021; Pearson et al., 2023; Swope et al., 2022). Extending the work from Fisk and colleagues, the relationship between living in historically redlined neighborhoods and global cognition along with specific cognitive domains has not been explored. It is plausible that specific cognitive domains may be differentially impacted by community context, as has been reported for other chronic stressors. For example, in previous work examining cognitive impacts of stressors among older Black adults, higher levels of perceived stress were associated with faster declines in global cognition and cognitive domains of episodic memory and visuospatial ability, but was not associated with semantic memory, working memory, or perceptual speed (Turner, James, Capuano, Aggarwal, & Barnes, 2017). Further, older Black adults living in communities with higher community-level Social Vulnerability Index scores (indicating greater social vulnerability) had lower initial global cognition and episodic memory, and slower decline in visuospatial abilities, though no other relationships were observed (Lamar et al., 2023).

To build upon this existing body of work, we examined the association of living in a historically redlined community with both level and change in global cognition, as well as in different domains of cognition, among a community-dwelling sample of older Black adults in Chicago, IL. Here, we use the grades from the HOLC maps as a place-based proxy for the culmination of decades of policies contributing to segregation, discrimination, and disinvestment that heavily impacted communities historically rated as “hazardous,” or redlined. In Chicago, historical inequities and discriminatory policies follow patterns that have large negative impacts on many of the communities that received low ratings on the HOLC maps (L. Chen, Conroy, Mitchell, & Meier, 2026; Nelson et al., 2021). According to the ecosocial framework, structural inequities at the community-level become “embodied” biologically and may be reflected in late life cognition due to chronic stressors, environmental exposures, economic deprivation, and limited resources resulting from these structural inequities. We hypothesized that participants currently residing in historically redlined communities would have worse cognition and faster decline in global cognition compared to those living in communities that were not redlined. Further, consistent with other studies of racialized stressors, we hypothesized that those living in redlined communities would score lower on all cognitive domains, but have faster decline in domains of episodic memory and visuospatial ability specifically (Barnes, Lewis, et al., 2012; L. B. Zahodne et al., 2020; Laura B. Zahodne, Sol, & Kraal, 2019).

Methods

Study Participants

Participants were older Black adults from the Minority Aging Research Study (MARS) and Rush Clinical Core (CC) (Barnes, Shah, Aggarwal, Bennett, & Schneider, 2012; Schneider, Aggarwal, Barnes, Boyle, & Bennett, 2009). Both are ongoing, longitudinal cohort studies of aging adults based in the Chicago metropolitan area. Participants in both studies were recruited from various community-based settings including churches, subsidized senior housing, social service agencies, clubs, fraternities, and sororities, and participants are also able to refer others to enroll. All study participants were non-institutionalized, over the age of 60, and without known dementia at baseline. Recruitment is done through community settings so that potential participants reflect a wide range of backgrounds, educational attainment, and lifestyle experiences. Study participants undergo annual uniform structured clinical evaluations in their residence, with a harmonized battery of measures that allow for combining data from both cohorts. Evaluations include a structured interview to collect information on demographics and a variety of lifestyle and behavioral characteristics. Additionally, participants undergo a neurological examination, a blood draw, and a battery of cognitive tests.

Of the total possible 1,267 Black participants across both studies with complete baseline data, 900 resided in areas within the City of Chicago which were graded by the Home Owners’ Loan Corporation. Of them, 190 were excluded due to having insufficient data on longitudinal global cognition and 34 were determined to have possible dementia at the baseline cohort assessment, resulting in an analytic sample of 676 participants.

Geocoding of Study Participants

Participants provided their home address at the time of their initial clinical evaluation or shortly thereafter. After addresses were reviewed and clerical errors corrected, addresses were geocoded using geographic information systems (GIS) mapping software (ESRI ArcGIS) and shapefiles provided by the U.S. Census (Bureau, 2020). The visit corresponding to the first valid address given by a participant was considered the analytic baseline for this study.

Home Owners’ Loan Corporation (HOLC) Grading

We used maps created in the late 1930s by the HOLC which assigned letter/color grades to defined areas based upon quality of housing, recent home sale and rent values, as well as the racial, ethnic, and socioeconomic status of residents. Maps produced by the HOLC have been digitized and made publicly available from the University of Richmond’s Mapping Inequality Project (Nelson et al., 2021) Grades were A “best”–green, B “still desirable”–blue, C “definitely declining”–yellow, and D “hazardous”–red. Communities graded as D were “redlined” and represented the areas that were deemed riskiest for lending, and typically were categorized in this manner due to having high proportions of Black, foreign-born, and/or lower income residents, older homes or homes in worse condition, fewer community amenities, and were closer to industrial areas with higher burdens of pollution (Nelson et al., 2021). For Chicago, detailed descriptions of the graded areas are available and give insight into the rationale for the grades given. As one example, the following is an excerpt from the description of Area D74, an area on the Southside of the city near Lake Michigan, where many of the current study participants live:

“Located between 35th and 67th, west of Cottage Grove to State, a blighted area, 100 per cent negro, predominantly apartment buildings; 3's, 6's and up, few 2's. Single homes are of the 6–10 room type, average age 40 years. In this area under construction is the Ida B. Wells US Housing Project, extending from 37th to 39th between South Parkway and Cottage Grove. This project is expected to house 1,662 negro families and, of course, will be taken off the tax rolls with the exception of taxes for police, fire and school purposes. This venture has the realtors guessing as to what the ultimate result will be when so many of this race are drawn into this section from the already negro-blighted district; particularly its effect on the section east and south of Cottage Grove, and to park and water frontage on Lake Michigan.”

(Nelson et al., 2021)

HOLC grades were linked to current participants’ residences using geocoded residential addresses at analytic baseline. Most MARS and CC participants reside on the South and West Sides of Chicago, areas which are historically segregated as most communities were assigned C and D grades by the HOLC, with few areas rated A or B.

Cognition Assessment

As part of the yearly in-home assessment, participants were administered 19 performance-based cognitive function tests (Wilson et al., 2015). Cognitive function tests from baseline and all follow-ups were included in analyses. The tests measure different cognitive abilities and can be combined to summarize performance across five cognitive domains: episodic memory (immediate and delayed recall of the East Boston story and Story A from Logical Memory, CERAD Word List Memory, Word List Recall, and Word List Recognition); semantic memory (15-item Boston Naming Test, Verbal Fluency, 15-item word reading test), working memory (Digit Span Forward, Digit Span Backward, Digit Ordering), visuospatial ability (Judgement of Line Orientation, Progressive Matrices), and perceptual speed (Symbol Digits Modality Test, Number Comparison, Stroop Color Naming, Stroop word reading).

Composite scores are calculated by converting raw scores on each test to Z-scores using baseline mean and standard deviation of the full analytic sample and averaging the z-scores to obtain a global cognitive function composite score. The global score is calculated provided that more than half of the z-scores are non-missing. The domain scores were similarly created by averaging z-scores of tests within each domain. Detailed information on the complete set of cognitive assessments has been published elsewhere (Wilson et al., 2015).

Participant and Community Characteristics

Covariates in this study included sociodemographic characteristics: age, sex, and years of education. We also considered health factors that are known to be related to racial stressors like residence in redlined neighborhoods and cognition, and that could potentially be on the causal pathway between the two: vascular risk factors, vascular diseases, and depressive symptoms (Deo et al., 2023; Ganguli et al., 2014; Mujahid et al., 2021; Pearson et al., 2023; Wilson et al., 2002). Vascular risk factors included a count of hypertension (self-report), diabetes (self-report or use of antidiabetic medications), and smoking history (former/current). Vascular disease burden included a count of claudication (self-report), stroke (self-report and based upon neurological exam and participant interview), and heart conditions (self-report, includes heart attack or coronary heart disease, coronary thrombosis, coronary occlusion, or myocardial infarction). Depressive symptoms were measured using a modified, 10-item version of the Centers for Epidemiologic Studies Depression scale (CES-D) (Kohout, Berkman, Evans, & Cornoni-Huntley, 1993; Radloff, 1977). All were measured at the analytic baseline.

To demonstrate the community-level demographic characteristics of the communities around the time that the HOLC maps were created, we included community characteristics (at the Census Tract level) from the 1940 Census that were likely considered when the HOLC grades were determined These characteristics included the percent of Black residents, the percentage of foreign-born white residents, employment rate, median rent, and median home value, and were obtained through the National Historical Geographic Information System (NHGIS) (Ruggles et al., 2025).

To understand potential relationships between current community characteristics by HOLC grade, we also included measures of current demographic characteristics (percent Black race by census tract from the American Community Survey), and community-level structural and socioeconomic factors (the national rank of the Area Deprivation Index at the census block group level (Kind & Buckingham, 2018) and the CDC Social Vulnerability Index (calculated at the census tract level) (Mah, Penwarden, Pott, Theou, & Andrew, 2023). Briefly, the Area Deprivation Index is a composite measure of the relative socioeconomic conditions of a community, and encompass domains of income, education, employment, and housing quality (Kind & Buckingham, 2018). The Social Vulnerability Index is a composite measure of socioeconomic, household, demographic, and housing/transportation related variables, and is used for identifying communities at high risk for natural or human-caused hazards, and public health emergencies (Kind & Buckingham, 2018). Higher scores on both indices indicate worse deprivation or vulnerability, respectively. We opted to test both indices as they measure slightly different constructs of community-level characteristics. In these cohorts, prior work demonstrated that the Social Vulnerability Index is associated with individual-level cognition and motor function among Black participants (Lamar et al., 2023).

Statistical Analyses

Baseline descriptive statistics for demographic characteristics, cognitive function, and community characteristics (both from 1940 and at the time of analytic baseline) were calculated and stratified by HOLC grade. For analyses, HOLC grades of “best” and “still desirable” were combined for two reasons: a) conceptually, as these areas were both considered favorable, and b) analytically, as fewer than 20% of communities in Chicago were graded “best” or “still desirable.” The distribution of participants and HOLC grades were mapped using ArcGIS. Statistical analyses were run using SAS version 9.4 (SAS Institute, Carey, NC, USA), except where otherwise noted.

The associations between the HOLC grades with level and change in cognition (including each cognitive domain) were tested using linear mixed models with random effects at the participant level. Initial models included time, HOLC grade, age, sex, and years of education, as well as all respective interactions with time, with the continuous global cognition and each of the 5 cognitive domains as separate outcomes. We then added vascular diseases, vascular risk factors, and depressive symptoms (and interactions with time) to determine whether relationships persisted after considering these potential mediators. In secondary analyses, we added separately each of the current-day community characteristics to the models that included age, sex, and years of education to determine whether relationships were independent of current community characteristics. To ensure results were not confounded by spatial correlations, we used two additional model types as a sensitivity analysis. First, to account for the clustering effects of sharing the same HOLC area among some participants, we added an additional random effect for nesting at the HOLC area level. Then, to account for the spatial correlation among participants living close to each other, we further introduced a spatial autocorrelation matrix to the model. These analyses were done using the spaMM R package (Rousset & Ferdy, 2014). This package allows nested random effects for clustering effects and uses the Matérn correlation function for spatial correlation based on longitude and latitude.

RESULTS

Among the sample of 676 older Black adults, 21% of participants currently reside in communities historically graded by the HOLC as “best/still desirable”, 46% reside in “definitely declining”, and 33% reside in “hazardous” or redlined communities. Maps of the overall participant distribution, and the spatial distribution of the historical HOLC grades among participants’ current communities are displayed in Figures 1 and 2, respectively. Also, as shown in Table 1, the contemporary percent of Black residents was high in all communities, regardless of historic HOLC grade, though appeared to be highest among the “definitely declining” communities. The current Social Vulnerability Index was high among all communities and appeared to be highest among the historically redlined communities. The current Area Deprivation Index was also high among all communities, with the highest values seen in the historically “definitely declining” communities. The historical community data indicates that few Black individuals resided in the “best/still desirable” and “definitely declining” communities, with a wide distribution of the percentage of Black individuals in the “hazardous” or redlined communities. In contrast, the highest percentage of foreign-born white residents were in the “definitely declining” communities. The percentage of employed residents, median rent, and median home values followed a gradient with “best/still desirable” communities having the highest values, “definitely declining” communities in the middle, and “hazardous” or redlined communities with the lowest.

Figure 1:

Figure 1:

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Distribution of MARS and AA Core participants by Chicago Community Area or suburban (Illinois and Indiana) municipality.

Figure 2:

Figure 2:

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Map of Home Owner’s Loan Corporation community gradings in the Chicago, IL region. Data are from the Mapping Inequality Project from the University of Richmond (Nelson et al., 2021)

Table 1:

Participant characteristics stratified by HOLC grade

HOLC Grade
Participant Characteristics “Best” or “Still Desirable”
N=143		 “Definitely Declining”
N=309		 “Hazardous” (Redlined)
N=224
Age, years, mean (SD) 74.1 (6.9) 74.2 (6.3) 74.6 (6.6)
Male sex, N (%) 116 (22.0) 230 (43.6) 181 (34.4)
Years of education, mean (SD) 15.4 (3.6) 14.9 (3.3) 14.1 (3.1)
Vascular risk factors*, median (IQR) 1 (1–2) 1 (1–2) 2 (1–2)
Vascular diseases**, median (IQR) 0 (0–0) 0 (0–0) 0 (0–0)
Depressive symptoms, median (IQR) 1 (0–2) 1 (0–2) 1 (0–2)
Cognition
Global cognition, mean (SD) 0.13 (0.59) 0.07 (0.56) −0.06 (0.56)
Episodic memory, mean (SD) 0.16 (0.69) 0.04 (0.66) −0.007 (0.73)
Semantic memory, mean (SD) 0.06 (0.80) 0.07 (0.75) −0.05 (0.75)
Working memory, mean (SD) 0.12 (0.70) 0.13 (0.82) −0.09 (0.80)
Visuospatial orientation, mean (SD) 0.17 (0.83) 0.12 (0.76) −0.09 (0.80)
Perceptual speed, mean (SD) 0.07 (0.84) −0.0 (0.73) −0.12 (0.75)
Community Characteristics at Baseline
Percent Black Race, median (IQR) 96.7 (93.0–97.7) 96.7 (89.7–97.8) 94.0 (78.8–97.6)
Social Vulnerable Index, mean (SD) 0.65 (0.21) 0.69 (0.18) 0.75 (0.19)
Area Deprivation Index National Rank, mean (SD) 53.2 (24.8) 57.6 (19.6) 51.4 (24.9)
Historical Community Characteristics from the 1940 Census ***
Percent Black Race, median (IQR) 0.0 (0.0–0.3) 0.0 (0–0.1) 4.1 (1.0–97.0)
Percent Foreign Born White, mean (SD 14.9 (3.5) 16.5 (5.5) 11.7 (9.3)
Percent Employed, mean (SD 42.1 (5.0) 40.5 (4.7) 35.3 (8.2)
Median Rent in Dollars, mean (SD 52.4 (8.0) 42.6 (14.0) 27.7 (12.2)
Median Home Value in Dollars, mean (SD 6,594 (3,801) 3,922 (2,754) 2,479 (1,813)
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*

Sum of hypertension, diabetes (based upon self-report or medication), and smoking (current or former)

**

Sum of claudication, stroke, and heart conditions (heart attack or coronary, coronary thrombosis, coronary occlusion, or myocardial infarction)

***

1940 Census data only available for census tracts that fall within the boundaries of the City of Chicago. Sample sizes for these measures are “Best” or “Still Desirable” N=134, “Definitely

Declining” N=284, and “Hazardous” (Redlined) N=215.

Abbreviations:

SD: Standard deviation

IQR: Interquartile range

Participants’ baseline mean age was 74.1 (SD: 6.5) years, mean years of education was 14.8 (SD: 3.4) years, 78.2% were female, and participants had an average of 1.5 (SD: 0.9) vascular risk factors. On average, participants were longitudinally followed for 8.0 (SD: 4.8) years. Participant characteristics, including the scores for global cognition and each of the five cognitive domains are displayed in Table 1, overall and stratified by HOLC grade.

For global cognition, compared to those in communities historically graded as “best/still desirable,” participants in historically redlined communities had lower initial global cognition (β=−0.14, SE=0.05, p=0.01) in primary models (Table 2; Model 1). In comparison, the beta estimate associated with each year of older age was associated with −0.028 lower global cognition (results not shown), meaning that the association between living in a Redlined community on initial level of cognition is approximately equivalent to the effect on cognition of being 5 years older at baseline. There was no difference between those residing in historically redlined communities and those residing in “definitely declining” communities in initial global cognition. There were no differences among areas historically categorized as redlined or “hazardous”, “best/still desirable”, or “definitely declining” in the rate of change in global cognition over time.

Table 2:

Associations between HOLC grade with baseline level and annual rate of change in global cognitive function, from linear mixed-effects models.

Model 1* Model 2**
Estimate
(SE)		 p-value Estimate
(SE)		 p-value
Baseline Level
“Best” or “Still Desirable” REF --- REF ---
“Definitely Declining” −0.04 (0.05) 0.38 −0.06 (0.05) 0.26
“Hazardous” (Redlined) −0.14 (0.05) 0.01 −0.14 (0.05) 0.001
Annual Rate of Change
“Best” or “Still Desirable” REF --- REF ---
“Definitely Declining” 0.01 (0.01) 0.23 0.01 (0.01) 0.27
“Hazardous” (Redlined) 0.02 (0.01) 0.07 0.02 (0.02) 0.09
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*

Model 1 was adjusted for time, age, sex, years of education, as well as the interactions with time for each covariate.

**

Model 2 was adjusted for all factors in Model 1 as well as potential mediators, including vascular risk factors (sum of hypertension, diabetes, and smoking), vascular disease burden (sum of claudication, stroke, and heart conditions), depressive symptoms, as well as interactions with time for each covariate.

When examining cognitive domains, those currently residing in historically redlined communities had lower initial episodic and working memory (β=−0.13, SE=0.07, p=0.04 and β=−0.17, SE=0.08, p=0.03, respectively). They also had slower decline in semantic memory (β=0.03, SE=0.01, p=0.04) compared to those in communities historically graded as “best/still desirable” (Table 3; Model 1). No differences existed for those in “definitely declining” communities compared to those in communities historically graded as “best/still desirable.” No associations were evident between any HOLC grade with visuospatial ability or perceptual speed.

Table 3:

Associations between historic HOLC grade with baseline level and annual rate of change in cognitive domains, from minimally (Model 1) and fully adjusted (Model 2) linear mixed-effects models.

Semantic Memory Episodic Memory Working Memory Visuospatial Ability Perceptual Speed
Estimate
(SE)		 p-value Estimate
(SE)		 p-value Estimate
(SE)		 p-value Estimate
(SE)		 p-value Estimate
(SE)		 p-value
Model 1 *
Baseline Level
“Best” or “Still Desirable” REF --- REF --- REF --- REF --- REF ---
“Declining” −0.02 (0.07) 0.82 −0.05 (0.06) 0.42 −0.03 (0.07) 0.71 −0.06 (0.07) 0.34 −0.05 (0.07) 0.47
“Hazardous” (Redlined) −0.10 (0.07) 0.18 −0.13 (0.07) 0.04 −0.17 (0.08) 0.03 −0.14 (0.07) 0.05 −0.13 (0.07) 0.08
Annual Rate of Change
“Best” or Still Desirable” REF --- REF --- REF --- REF --- REF ---
“Declining” 0.01 (0.01) 0.63 0.02 (0.01) 0.17 0.01 (0.01) 0.30 0.01 (0.01) 0.08 0.01 (0.01) 0.50
“Hazardous” (Redlined) 0.03 (0.01) 0.03 0.02 (0.01) 0.07 0.01 (0.01) 0.27 0.02 (0.01) 0.05 −0.001 (0.001) 0.93
Model 2 **
Baseline Level
“Best” or “Still Desirable” REF --- REF --- REF --- REF --- REF ---
“Declining” −0.02 (0.07) 0.75 −0.07 (0.07) 0.27 −0.03 (0.07) 0.73 −0.07 (0.07) 0.29 −0.05 (0.07) 0.49
“Hazardous” (Redlined) −0.10 (0.07) 0.22 −0.15 (0.07) 0.02 −0.17 (0.08) 0.04 −0.14 (0.07) 0.05 −0.10 (0.07) 0.14
Annual Rate of Change
“Best” or “Still Desirable” REF --- REF --- REF --- REF --- REF ---
“Declining” 0.01 (0.01) 0.64 0.01 (0.01) 0.26 0.01 (0.01) 0.26 0.02 (0.01) 0.06 0.01 (0.01) 0.37
“Hazardous” (Redlined) 0.03 (0.01) 0.04 0.02 (0.01) 0.16 0.01 (0.01) 0.17 0.02 (0.01) 0.05 0.003 (0.01) 0.77
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*

Model 1 was adjusted for time, age, sex, years of education, as well as the interactions with time for each covariate.

**

Model 2 was adjusted for all factors in Model 1 as well as potential mediators, including vascular risk factors (sum of hypertension, diabetes, and smoking), vascular disease burden (sum of claudication, stroke, and heart conditions), depressive symptoms, as well as interactions with time for each covariate.

When adding vascular risk factors, vascular diseases, and depressive symptoms to models, statistically significant associations from the primary models remained consistent, and estimates were generally unchanged (Tables 2 and 3: Model 2), indicating that the observed associations are independent of these factors.

In secondary models testing whether associations remained when accounting for current community characteristics, none of the community characteristics were significantly related to level or change in global cognition. When accounting for current community characteristics, the association of participants in redlined communities having lower initial global cognition remained statistically significant (global cognition for redlined communities β=−0.11, p=0.04 when adjusting for SVI and β=−0.13, p=0.02 when adjusting for ADI; full results in Supplemental Tables S1–S3). A higher percentage of Black residents in a community was associated with higher semantic memory (β=0.002, SE=0.001, p=0.04) for each additional percentage point of residents of Black race and the association between participants in redlined communities having slower decline in semantic memory remained (β=0.03, SE=0.01, p=0.03). No other associations between current community-level characteristics existed.

In sensitivity analyses accounting for potential spatial clustering, we found no evidence of a nested random effect, and the results remained consistent with the original longitudinal mixed models that only contained the person-specific random effect. In the nested models, the main effect estimates were β=−0.04 (SE=0.05, p=0.38) for “definitely declining” communities versus “best” or “still desirable” communities, β=−0.14 (SE= 0.05, p=0.01) for “hazardous” or redlined communities versus “best” or “still desirable” communities, and neither interaction term with time was statistically significant—which are all consistent with the estimates of the main models (Table 2). Similarly, in models accounting for spatial autocorrelation, the main effect estimates were β=−0.04 (SE=0.05, p=0.41) for “definitely declining” communities versus “best” or “still desirable” communities, β=−0.14 (SE. 0.05, p=0.01) for “hazardous” or redlined communities versus “best” or “still desirable” communities, and neither interaction term with time was statistically significant. Together, these results confirm the robustness of the main findings.

DISCUSSION

In this sample of older Black adults from metropolitan Chicago, we found that those currently living in communities that were historically redlined had lower initial global cognition, as well as lower initial episodic and working memory. Living in a historically redlined community was not associated with faster rate of decline in global cognition but was surprisingly associated with slower decline in semantic memory. These results were independent of individual-level demographics and persisted when considering potential health-related mediators and were independent of current day community characteristics.

These results indicate that the effects associated with living in a redlined community on cognition were limited only to starting level of cognition, not to change in cognition over time, suggesting that this proxy measure of structural inequity is not a marker of underlying disease that leads to cognitive decline. Rather, the association between living in a historically Redlined community on the initial level of global cognition is approximately equivalent to the effect on cognition of being 5 years older at baseline. Though we cannot make causal inferences from these results, our conceptualization of redlining as a proxy for sustained segregation, disinvestment, and lack of resources may indicate that the historical context of the community may be related to cognition in ways that are not fully captured by only looking at contemporary community characteristics, particularly since many associations between residing in historically redlined communities and cognition persisted when adjusting for current-day characteristics.

We found that those living in historically redlined communities showed slower decline in semantic memory. While the basis of this association is unclear, it is possible that the results are due to a selective survival effect where the most resilient Black adults survived to old age despite living in disinvested redlined communities. It is also plausible that certain features of highly segregated neighborhoods, like social cohesion, social support, and cognitive capital provide protective effects within neighborhoods and shield residents from the negative effects of discrimination and prejudice experienced more broadly, potentially protecting cognition (Ferraro & Han, 2025; Meyer et al., 2023). For example, a stronger sense of neighborhood belonging, a characteristic feature of segregated neighborhoods of minoritized persons, is associated with better physical, mental, and general health (Clark, Engelman, Schultz, Bersch, & Malecki, 2024). Interestingly, a higher percentage of Black residents in a community was associated with higher semantic memory, perhaps consistent with the idea of neighborhood belonging and social cohesion. Another possibility for the slower semantic memory decline result is that semantic memory, unlike episodic memory, may be enhanced by stress because retrieval level processing relies on neural networks outside the typical stress-mediated pathways (e.g., striatal and neocortical pathways as opposed to hippocampal pathways), as proposed by others (A. M. Smith, Hughes, Davis, & Thomas, 2019). Albeit, this may be more true for acute stress than chronic stress (Shields et al., 2017). Finally, perhaps slower semantic memory decline in this sample is influenced by unique cultural traditions, such as story creation and storytelling among Black Americans, whereby wisdom and lived experiences are orally passed down through generations (Banks-Wallace, 2002), strengthening the acquisition of semantic memory—i.e., long-term memory for facts and knowledge. Future research is needed to examine these and other possibilities.

Overall, these results are generally consistent with existing literature that demonstrates lasting effects that historical discriminatory practices and policies can have on health. However, they vary slightly from the only other study (to our knowledge) that has examined the association between redlining and cognitive function among older adults (Fisk et al., 2025). Like us, the previous work in HRS indicated that Black participants in redlined communities had lower initial cognition, but slower decline in cognition compared to those in “best” or “still desirable” communities. But the previous work also showed evidence of a crossover effect with age, such that the differences between those in redlined versus “best” or “still desirable” communities that was evident around the age of 50 narrowed around the ages of 65–70 years and began to reverse thereafter. Our cohorts had a mean baseline age of 75 years, making results difficult to directly compare as we would not be able to observe the crossover effect if it existed within the current study’s data. Survival bias also makes these results difficult to compare as participants in the current study had to be alive and healthy enough by at least age 60 to join an aging cohort study. Differences in findings may also be due to the cognitive assessment methods and tests used, or potentially due to differing associations between historical redlining and cognition by other local factors, as our study focused on Chicago while HRS is nationwide.

A growing body of aging research has been focusing on how community conditions can contribute to cognition and risk of dementia. Communities with amenities that encourage physical, cognitive, and social activity (e.g., high walkability, plentiful green spaces, libraries, and community centers) are hypothesized to promote better cognition among older adults (Besser, McDonald, Song, Kukull, & Rodriguez, 2017; X. Chen et al., 2022; Clarke et al., 2012). However, these resources are not distributed equally, and this unequal resource distribution contributes to disparities in health as a function of race/ethnicity and socioeconomic status (Steil & Arcaya, 2023), as Black residents and people from low SES backgrounds are more likely to live in under resourced communities (LaVeist, 2003). Indeed, most participants in this study lived in communities that were historically deemed “hazardous” (i.e. redlined communities) or “definitely declining” by the HOLC nearly 90 years ago, demonstrating the pervasiveness of the policies and forces that contribute to sustained segregation and uneven resource distribution. Present-day patterns of segregation largely mirror the historical redlining maps, both in Chicago and in many cities across the United States (Egede et al., 2023). When we adjusted for contemporary community characteristics that reflect demographics and community disadvantage (the Area Deprivation Index and Social Vulnerability Index), results remained consistent. Further work determining whether community amenities buffer negative associations between historical context and cognitive function may be warranted.

Other studies have examined potential associations with residential segregation—which was evident at the time the HOLC maps were created and persist today. Though we did not measure segregation directly, we found that higher percentage of Black residents in a community was associated with higher level of semantic memory, but no association with global cognition or other cognitive domains. Findings regarding segregation and cognition in other studies have been mixed, particularly when attempting to elucidate how segregation may explain racial differences in cognition. In the Multi-Ethnic Study of Atherosclerosis (N=1,712 older adults), higher levels of community racial segregation were related to faster declines in processing speed among older Black participants, but there was no association for other racial or ethnic groups, and no associations with global cognition (Besser et al., 2023). On the other hand, another study from the HRS (N=6,150 adults age 50+ years) found that overall, greater community-level Hispanic composition and Hispanic-white segregation was related to higher initial level but faster decline in cognition, but there was no association for community Black composition or Black-white community segregation (Kovalchik et al., 2015). Interestingly, the effect of community-level segregation on cognitive function did not vary by individual-level race or ethnicity. From a methodological perspective, the racial distribution differences of residential communities inherent to segregation make it difficult to study, particularly for making comparisons by race, potentially contributing to inconsistent findings found in prior work (Whitfield, Allaire, Belue, & Edwards, 2008). Hence, our investigation adds to the literature due to our focus on heterogeneity specifically among Black older adults, rather than between racial groups, as it allowed us to focus on unique experiences that are related to race that may impact cognitive health and may be masked in a between race investigation.

Strengths of this work include the longitudinal, comprehensive assessments of cognitive function allowing us to examine longitudinal relationships with global cognition, and five cognitive domains. However, this study was limited to the metropolitan Chicago area, and further study in other cities and municipalities is needed to understand how generalizable these findings are. We also do not know the extent that current residence is reflective of where participants lived long term prior to enrolling in our studies, or how long they lived in their current community. From prior work in these cohorts, we know that a sizeable portion of participants were born in the Southern U.S., and many of those participants were still living in the South at age 12 years (Lamar et al., 2020). A future direction of this work is to characterize early-life community exposures in relation to late life cognition.

Historic community context is associated with cognitive function among older Black adults, largely showing negative associations between residing in a redlined community and cognition. Individual-level interventions are often posed for reducing disparities or alleviating impacts of adverse exposures, however, the fact that associations between historical redlining and poor health have persisted for decades indicates that policy and community-level solutions may be needed to address the persistent segregation and community disinvestment, not only for late life cognition, but to address a wide array of health outcomes across the lifespan.

Supplementary Material

Supplementary Material

Highlights.

  • Living in a historically redlined community is often associated with worse health.

  • Few studies regarding redlining have focused on late-life cognitive health.

  • We tested associations between redlining and cognition among older Black adults.

  • Residing in a redlined community was related to worse initial cognition.

  • However, it was also associated with slower semantic memory decline.

ACKNOWLEDGEMENTS

We sincerely thank the participants of the Minority Aging Research Study and African American Clinical Core of the Rush Alzheimer’s Disease Center for their considerable altruism over the years. We also acknowledge the hard work of the study coordinators, data and analytic programmers, and staff and faculty of the Rush Alzheimer’s Disease Center.

FUNDING

This study was supported by the National Institutes of Health (NIH), grant numbers, R01 AG22018, P30 AG072975, R01 AG062711, and R03 AG071943.

Footnotes

Declaration of Interest

Authors declare no relevant conflicts of interest for this study.

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