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Effects of housing stability and contemporary mortgage lending bias on breast cancer stage at diagnosis among older women in the United States. Cancer Med 2024 Jul;13(14):e7397

Date

07/20/2024

Pubmed ID

39030995

Pubmed Central ID

PMC11258551

DOI

10.1002/cam4.7397

Scopus ID

2-s2.0-85199018217 (requires institutional sign-in at Scopus site)

Abstract

BACKGROUND: Interventions aimed at upstream factors contributing to late-stage diagnoses could reduce disparities and improve breast cancer outcomes. This study examines the association between measures of housing stability and contemporary mortgage lending bias on breast cancer stage at diagnosis among older women in the United States.

METHODS: We studied 67,588 women aged 66-90 from the SEER-Medicare linked database (2010-2015). The primary outcome was breast cancer stage at diagnosis. Multinomial regression models adjusted for individual and neighborhood socio-economic factors were performed using a three-category outcome (stage 0, early stage, and late stage). Key census tract-level independent variables were residence in the same house as the previous year, owner-occupied homes, and an index of contemporary mortgage lending bias.

RESULTS: In models adjusted for individual factors, higher levels of mortgage lending bias were associated with later stage diagnosis (RR = 1.10, 95% CI 1.02-1.20; RR = 1.31, 95% CI 1.16-1.49; RR = 1.41, 95% CI 1.24-1.60 for least to high, respectively). In models adjusted for individual and neighborhood socio-economic factors, moderate and high levels of mortgage lending bias were associated with later stage diagnosis (RR = 1.16, 95% CI 1.02-1.33 for moderate and RR = 1.18, 95% CI 1.02-1.37 for high). Owner occupancy and tenure were not associated with later stage diagnosis in adjusted models.

CONCLUSIONS: Contemporary mortgage lending bias demonstrated a significant gradient relationship with later stage at diagnosis of breast cancer. Policy interventions aimed at reducing place-based mortgage disinvestment and its impacts on local resources and opportunities should be considered as part of an overall strategy to decrease late-stage breast cancer diagnosis and improve prognosis.

Author List

Rademacher N, Zhou Y, McGinley EL, Laud PW, Yen TWF, Ponce SB, Nattinger AB, Beyer KMM

Authors

Kirsten M. Beyer PhD, MPH Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Purushottam W. Laud PhD Adjunct Professor in the Data Science Institute 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
Female
Housing
Humans
Medicare
Neoplasm Staging
SEER Program
Socioeconomic Factors
United States