Racial health disparities persist in hospital care access, quality, and outcomes. These disparities are geographically patterned but paradoxically hospital proximity is not protective. Historical governmental policies such as redlining may explain this paradox. Redlining, proxied by explicitly race-based maps drawn by the Home Owners' Loan Corporation (HOLC) in the 1930s, led to extensive depopulation, property devaluation, and political disempowerment in neighborhoods with significant proportions of Black residents in the latter half of the 20th centuries. Hospitals expanding in the post-World War II period due to the Hill-Burton Act may have taken advantage of these racialized economic and political gradients. Our study investigates whether historical HOLC redlining categories are associated with present day hospital location and size. We used hospital locations from the 2023 Homeland Infrastructure Foundation-Level hospital dataset and redlining locations and categories from the Mapping Inequality dataset. We calculated expected counts of hospitals and total number of beds based on the proportion of land covered by each HOLC category. We compared observed counts of hospitals and beds using Pearson chi-squared tests. Hospitals were significantly overrepresented in HOLC D red areas by 20.5 % and underrepresented in HOLC A green areas by 35.6 %. Hospital beds were overrepresented in D areas by 56.5 % and underrepresented by 44.7 % in A, 5.2 % in B, and 20.8 % in C. We show that hospital locations are not evenly distributed throughout the US with regard to 1930s HOLC categories. The expansion of hospital capacity in the post-World War II period may have taken advantage of exploitative policies. Hospitals have the ability and opportunity to correct past injustices and improve health equity today by increasing investments in community benefits.

Objective: We examined cross-sectional associations between mid-pregnancy food intake indicators and prenatal depressive symptomatology. Methods: This secondary analysis of the Comparison of Two Screening Strategies for Gestational Diabetes (GDM2) trial (N = 716) examined five domains of mid-pregnancy food intake (direct timing, energy timing, meal/snack structure, meal energy distribution, and diet quality) derived from 24 h dietary recalls. Depressive symptoms were measured with the Edinburgh Postnatal Depression Scale (EPDS). Generalized linear models examined associations between food intake indicators and both total and high (EPDS ≥ 13) depressive symptoms. Results: The mean (SD) EPDS score was 6.3 (4.9); a total of 12.4% (n = 89) of subjects had high depressive symptoms. Eating frequency (exp(B) = 1.084 [1.021, 1.151], p = 0.008), snack frequency (exp(B) = 1.063 [1.004, 1.126], p = 0.037), nighttime snacking frequency (exp(B) = 1.060 [1.003, 0.121], p = 0.040), and total daily energy intake (exp(B) = 1.058 [1.002, 1.118], p = 0.044) were positively associated with total depressive symptoms. Energy intake from breakfast (PR = 1.178 [1.029, 1.349], p = 0.017) was associated with higher prevalence of high depressive symptoms. Energy intake from dinner (PR = 0.809 [0.695, 0.943], p = 0.007), a later timing of the first eating episode (PR = 0.830 [0.699, 0.986], p = 0.034) and the first energy quartile (PR = 0.837 [0.702, 0.998], p = 0.048) were associated with lower prevalence of high depressive symptoms. Conclusions: These findings extend the prior chrononutrition–depression literature to the prenatal period, implicating eating frequency, energy intake, and meal energy timing and distribution in depressive symptomatology during pregnancy, and warrant further longitudinal investigation.