Table 6.
Area-level housing discrimination and cancer outcomesa
| Reference | Setting, data source, year, and sample size | Housing-related measures | Cancer outcomes | Key findings |
|---|---|---|---|---|
| Krieger et al. 2020 (47) | 28 municipalities in MA, Massachusetts Cancer Registry data, Jan 1, 2001–Dec 31, 2015, 53 196 adults ≥18 y diagnosed with breast, colorectum, lung, and cervical cancer | Historically redlined areas based on HOLC grade | Late stage at diagnosis for cervical, breast, lung, and colorectal cancer | Living in historically redlined areas was more likely to have increased risk of late-stage diagnosis than living in nonhistorically redlined areas for women with breast cancer (aRR = 1.07, 95% CI = 0.98 to 1.17), men with lung cancer (aRR = 1.07, 95% CI = 1.02 to 1.13), and men or women with lung cancer, aRR = 1.03, 95% CI = 1.00 to 1.17, adjusting for sex, gender, and race or ethnicity) |
| Nardone et al. 2020 (48) | 9 Cities, CDC 500 Cities database, 2018, 4061 adults aged >18 y diagnosed with a nondermatologic cancer | Historically redlined areas based on HOLC grade | Census tract level age- standardized cancer prevalence | Individuals living in historically redlined areas more likely to be diagnosed with nondermatologic cancer than living in nonhistorically redlined areas (r = −0.32, P < .001) |
| Poulson et al. 2021 (49) | Boston and surrounding suburbs, Boston Medical Center Clinical Database Warehouse and Lung Cancer Screening Program, March 1, 2015–March 31, 2017, 1063 adults aged 55–80 y | Historically redlined areas based on HOLC grade | Completion of lung cancer screening | With race as mediator, Black patients living in historically redlined areas 61% less likely to undergo screening than White patients (OR = 0.39, 95% CI = 0.24 to 0.64). Similarly, Black women and Black men living in historically redlined areas 61% less likely (OR = 0.39, 95% CI = 0.21 to 0.73) and 47% less likely (OR = 0.53, 95% CI = 0.29 to 0.98) to undergo screening than White men |
| Collin et al. 2021 (50) | Metropolitan Atlanta area, GA, Georgia Cancer Registry, 2010–2014, 8523 women aged ≥18 y diagnosed with breast cancer | Racial bias in mortgage lending, and neighborhood rate of mortgage denial | Breast cancer-specific mortality | For all women, after adjusting for age and stage at diagnosis, living in high (≥1) mortgage denial rate neighborhoods was more likely to have increased hazard of breast cancer mortality (aHR = 1.58, 95% CI = 1.37 to 1.82) than living in low (<1) mortgage denial rate neighborhoods. Living in neighborhoods with higher (≥3) racial bias in mortgage lending more likely to have decreased hazard of breast cancer mortality (aHR = 0.86, 95% CI = 0.75 to 0.99) than living in neighborhoods with lower (<3) racial bias in mortgage lending. For NHB and NHW women, living in high (≥1) mortgage denial rate neighborhoods more likely to have increased hazard of breast cancer mortality (aHR = 1.13, 95% CI = 0.90 to 1.42 and aHR = 1.39, 95% CI = 1.09 to 1.78, respectively) than living in low (<1) mortgage denial rate neighborhoods. For NHB and NHW women, living in neighborhoods with higher (≥3) racial bias no more likely to have increased hazard of breast cancer mortality (aHR = 1.08, 95% CI = 0.89 to 1.32, and aHR = 0.93, 95% CI = 0.74 to 1.16, respectively) than living in neighborhoods with lower (<3) racial bias in mortgage lending. |
| Beyer et al. 2021 (51) | National, SEER-Medicare, 2007–2015, 27 516 women aged 66–90 y diagnosed with breast cancer | Neighborhood mortgage denial rate | All-cause mortality and breast cancer-specific mortality | Residing in areas with higher mortgage denial rate more likely to have increased hazard ratios of all-cause mortality (low, aHR = 1.10, 95% CI = 1.06 to 1.14; moderate, aHR = 1.27, 95% CI = 1.17 to 1.38; and high, aHR = 1.39, 95% CI = 1.25 to 1.55) compared with reference level of 0.5 (corresponding to neighborhoods with lowest rate of mortgage denial) among women with no comorbidities after adjusting for race and ethnicity. A similar pattern was found for breast cancer–specific mortality and for women with no comorbidities (low, aHR = 1.08, 95% CI = 1.02 to 1.13; moderate, aHR = 1.20, 95% CI = 1.05 to 1.37; and high, aHR = 1.28, 95% CI = 1.06 to 1.55). |
| Zhou et al. 2017 (52) |
|
Racial bias in mortgage lending, and neighborhood rate of mortgage denial | All-cause and colorectal cancer-specific mortality | Residing in areas with higher (≥2) racial bias in mortgage lending more likely to have increased hazard of all-cause mortality (aHR = 1.37, 95% CI = 1.06 to 1.76) among Black colorectal cancer patients and among Black women (aHR = 1.53, 95% CI = 1.06 to 2.21), but not Black men, compared with residing in areas with lower (<2) racial bias in mortgage lending, after adjusting for age, sex, and stage at diagnosis. |
| Beyer et al. 2016 (53) |
|
Racial bias in mortgage lending, and neighborhood rate of mortgage denial | All-cause mortality and breast cancer-specific mortality | After adjusting for age, stage at diagnosis, and ZCTA population density, residing in areas with higher racial bias in mortgage lending more likely to have increased hazard of all-cause mortality (aHR = 1.16, 95% CI = 1.04 to 1.29) than residing in areas with lower racial bias in mortgage lending among Black women diagnosed with breast cancer. Residing in high mortgage denial rate neighborhoods more likely to have decreased hazard of all-cause mortality (aHR = 0.73, 95% CI = 0.59 to 0.90) than residing in areas with lower racial bias in mortgage lending among Black women diagnosed with breast cancer. After adjusting for age, stage at diagnosis, and ZCTA population density, residing in areas with higher racial bias in mortgage lending no more likely to have increased hazard of breast cancer–specific mortality (aHR = 1.12, 95% CI = 0.98 to 1.28) than residing in areas with lower racial bias in mortgage lending among Black women diagnosed with breast cancer. Residing in neighborhoods with higher racial bias in mortgage lending more likely to have decreased hazard of breast cancer–specific mortality (aHR = 0.76, 95% CI = 0.59 to 0.98) than residing in areas with lower racial bias in mortgage lending among Black women diagnosed with breast cancer. |
| Beyer et al. 2019 (55) | Large US MSAs, National Vital Statistics System, National Program of Cancer Registries, and SEER, 2009–2013, >500 000 adults aged ≥25 y | Racial bias in mortgage lending | Black-White disparity in cancer incidence and mortality rates | In areas with higher racial bias in mortgage lending, Black-White disparity in cancer mortality rate was larger (r = 0.32; P = .001). This relationship persisted in sex-specific analyses (females, r = 0.23; P = .02; males, r = 0.37; P < .001) and in models controlling for confounders. Adjusting for racial disparities in cancer incidence attenuated but did not eliminate correlation between racial bias in mortgage lending and racial disparities in mortality r = 0.24, P = .02; females, r = 0.22, P = .04; males, r = 0.22, P = .04. |
a
aHR = adjusted hazard ratio; CI = confidence interval; CDC = Centers for Disease Control and Prevention; HOLC = Home Owners’ Loan Corporation; HR = hazard ratio; IRR = incidence risk ratio; MSAs = metropolitan statistical areas; NHB = non-Hispanic Black; NHW = non-Hispanic White; RR = risk ratio; SEER = Surveillance, Epidemiology, and End Results Program; WONDER = Wide-ranging Online Data for Epidemiologic Research.