Faculty Collaboration Database

Mortgage Lending Bias and Breast Cancer Survival Among Older Women in the United States. J Clin Oncol 2021 Sep 01;39(25):2749-2757

Date

06/16/2021

Pubmed ID

34129388

Pubmed Central ID

PMC8407650

DOI

10.1200/JCO.21.00112

Scopus ID

2-s2.0-85115440319 (requires institutional sign-in at Scopus site)   32 Citations

Abstract

PURPOSE: The objective was to examine the relationship between contemporary redlining (mortgage lending bias on the basis of property location) and survival among older women with breast cancer in the United States.

METHODS: A redlining index using Home Mortgage Disclosure Act data (2007-2013) was linked by census tract with a SEER-Medicare cohort of 27,516 women age 66-90 years with an initial diagnosis of stage I-IV breast cancer in 2007-2009 and follow-up through 2015. Cox proportional hazards models were used to examine the relationship between redlining and both all-cause and breast cancer-specific mortality, accounting for covariates.

RESULTS: Overall, 34% of non-Hispanic White, 57% of Hispanic, and 79% of non-Hispanic Black individuals lived in redlined tracts. As the redlining index increased, women experienced poorer survival. This effect was strongest for women with no comorbid conditions, who comprised 54% of the sample. For redlining index values of 1 (low), 2 (moderate), and 3 (high), as compared with 0.5 (least), hazard ratios (HRs) (and 95% CIs) for all-cause mortality were HR = 1.10 (1.06 to 1.14), HR = 1.27 (1.17 to 1.38), and HR = 1.39 (1.25 to 1.55), respectively, among women with no comorbidities. A similar pattern was found for breast cancer-specific mortality.

CONCLUSION: Contemporary redlining is associated with poorer breast cancer survival. The impact of this bias is emphasized by the pronounced effect even among women with health insurance (Medicare) and no comorbid conditions. The magnitude of this neighborhood level effect demands an increased focus on upstream determinants of health to support comprehensive patient care. The housing sector actively reveals structural racism and economic disinvestment and is an actionable policy target to mitigate adverse upstream health determinants for the benefit of patients with cancer.

Author List

Beyer KMM, Zhou Y, Laud PW, McGinley EL, Yen TWF, Jankowski C, Rademacher N, Namin S, Kwarteng J, Beltrán Ponce S, Nattinger AB

Authors

Kirsten M. Beyer PhD, MPH Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Jamila L. Kwarteng PhD Assistant Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Purushottam W. Laud PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Emily L. McGinley Biostatistician III in the Center for Advancing Population Science department at Medical College of Wisconsin
Ann B. Nattinger MD, MPH Associate Provost, Professor in the Medicine department at Medical College of Wisconsin
Tina W F Yen MD, MS Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Aged, 80 and over
Breast Neoplasms
Cohort Studies
Comorbidity
Female
Follow-Up Studies
Health Status Disparities
Housing
Humans
Medicare
Prognosis
Racism
Residence Characteristics
Survival Rate
United States