Recent findings showed that historical housing discrimination may negatively affect contemporary care and outcomes for patients diagnosed with colon cancer, according to a study by Hussaini et al in the Journal of Clinical Oncology. The findings were also presented at the 2022 ASCO Quality Care Symposium (Abstract 69).
According to the senior author of the study, Leticia Nogueira, PhD, MPH, a senior principal scientist in the Surveillance & Health Equity Science Department at the American Cancer Society, in the 1930s, the federally sponsored Home Owners’ Loan Corporation created maps that directed mortgage financing based largely on a neighborhood’s racial composition. American neighborhoods were subdivided into four risk-based rankings for mortgage approvals and denials: A for the best neighborhoods, B for still desirable, C for in decline, and D for hazardous; D neighborhoods were mapped in red. “Redlining” resulted in racial segregation and systemic disinvestment in communities targeted for marginalization.
Leticia Nogueira, PhD, MPH
In the current study, researchers investigated the association between historical housing discrimination and contemporary, late-stage diagnoses; receipt of timely, guideline-concordant care; and survival outcomes in colon cancer—a leading cause of cancer deaths and a disease amenable to early detection and treatment.
Study Details
Study authors identified 98,335 individuals from the National Cancer Database diagnosed with colon cancer from 2007 to 2017. Individuals residing within known zip code tabulation areas in 196 cities with Home Owners’ Loan Corporation coverage greater than 10% were included. Residences were assigned a Home Owners’ Loan Corporation grade of A, B, C, or D based on the majority of the Home Owners’ Loan Corporation area represented. Multivariable logistic regression models (adjusted for age and sex) were used to investigate the association of housing discrimination and stage III and IV cancer diagnoses, the time to adjuvant chemotherapy initiation following surgery, and non–guideline-concordant care (no chemotherapy, surgery, or evaluation of fewer than 12 lymph nodes) based on patients’ eligibility for treatment. Multivariable Cox proportional hazard models using age as a measure of time were used to investigate the association between housing discrimination and overall survival.
Effect of Area on Outcomes
Compared with individuals living in majority Home Owners’ Loan Corporation A zip code tabulation areas, individuals living in majority Home Owners’ Loan Corporation D areas had higher odds of a late-stage diagnosis, and individuals living in majority Home Owners’ Loan Corporation areas B, C, or D had higher odds of non–guideline-concordant colon cancer care, with an increased time to chemotherapy initiation. For people living in majority Home Owners’ Loan Corporation areas C and D, overall survival rates for all stages—and especially early-stage—disease were lower when compared with those living in Home Owners’ Loan Corporation A zip code tabulation areas.
Researchers said the findings underscore the importance of state- and federal-level practices on mortgage lending regulation and fair housing practices in determining equitable cancer risk, access to care, and outcomes.
Disclosure: For full disclosure of the study authors, visit ascopubs.org.
