Findings reported by researchers from the American Cancer Society (ACS) and Johns Hopkins University showed that area-level mortgage discrimination may be adversely associated with receipt of guideline-concordant care among patients with non–small cell lung cancer (NSCLC) in the United States, according to a new study published by Fan et al in the Journal of Clinical Oncology. The findings were also presented at the 2022 ASCO Quality Care Symposium (Abstract 3).
Lead study author Qinjin Fan, PhD, Senior Scientist in Health Services Research at ACS, said that disparities in receipt of care for NSCLC are well described. Discriminatory mortgage lending, which limits access to home ownership in specific neighborhoods overall and disproportionately for racialized groups, is a marker of systemic racism and lower levels of neighborhood investment. This may, in turn, decrease access to high-quality cancer care.
Study Methodology
Researchers used the mortgage denial rate as a measure of area-level housing discrimination and investigated its association with guideline-concordant NSCLC care. Rates were estimated at the zip code tabulation areas level using the Home Mortgage Disclosure Act database from 2014 to 2019. Mortgage denial rates represented the proportion of denied home loans to the total completed home loans and were categorized into quartiles. Individuals older than 18 years of age diagnosed with NSCLC from 2014 to 2019 were identified from the National Cancer Database and combined with Home Mortgage Disclosure Act data. Multivariable logistic regression models examined associations between mortgage discrimination and receipt of guideline-concordant care—including surgery, chemotherapy, and chemoradiation. A multivariable Cox proportional hazard model examined the association between mortgage discrimination and the time to chemotherapy initiation.
The study included 450,614 patients newly diagnosed with NSCLC, residing in 33,120 zip code tabulation areas.
Results
Individuals residing in zip code tabulation areas with higher mortgage denial rates were more likely to be aged 45 to 64 years old, male, and to have an income less than $40,000/year. Overall, 69% of patients received guideline-concordant care. The likelihood of receiving guideline-concordant care was lower in neighborhoods with higher mortgage denial rates, adjusting for age and sex. This disparity was present in all care subgroups, and the time to chemotherapy initiation was longer for patients in neighborhoods with higher mortgage denial rates.
The researchers’ examination of institutional practices leading to barriers in resource access highlights the critical need to understand the pathways through which area-level mortgage denials adversely impact the receipt of equitable cancer care.
Disclosure: For full disclosures of the study authors, visit ascopubs.org.
