Historical Redlining, Contemporary Mortgage Discrimination Linked to Breast Cancer Outcomes

Historical redlining and contemporary mortgage discrimination are associated with breast cancer outcomes, according to research published in JAMA Network Open.

Researchers found that living in areas with historical redlining and persistent mortgage discrimination was associated with the risk of estrogen-receptor (ER)-negative breast cancer, being diagnosed with late-stage breast cancer, and breast cancer death. However, these outcomes differed between Black and White patients.

For this study, researchers evaluated 1764 women who were diagnosed with breast cancer and lived within census tracts that were graded by the Home Owners’ Loan Corporation in Georgia. Slightly more than half of patients (51.5%) were non-Hispanic White, and 48.5% were non-Hispanic Black.

Historical Redlining

Most patients (69.5%) lived in census tracts with historical redlining scores of 2.5 or higher (69.5%), which means these areas were considered high risk for investment.

In an age-adjusted analysis, patients who lived in areas with historical redlining scores of 2.5 or higher were more likely to have ER-negative breast cancer (odds ratio [OR], 1.72; 95% CI, 1.30-2.27). This was true for non-Hispanic Black patients (OR, 1.62; 95% CI, 1.01-2.60) but not for non-Hispanic White patients (OR, 0.85; 95% CI, 0.57-1.28).

The researchers also found, in an age-adjusted analysis, that patients who lived in areas with historical redlining scores of 2.5 or higher were more likely to have late-stage disease at diagnosis (OR, 1.75; 95% CI, 1.25-2.45). This was true for non-Hispanic White patients (OR, 1.97; 95% CI, 1.15-3.36) but not for non-Hispanic Black patients (OR, 0.78; 95% CI, 0.49-1.26).

Patients who lived in areas with historical redlining scores of 2.5 or higher had a higher risk of breast cancer death in an age-adjusted analysis (hazard ratio [HR], 1.60; 95% CI, 1.17-2.18) but not in a multivariable analysis (HR, 1.18; 95% CI, 0.87-1.62).

There were no significant associations between historical redlining and breast cancer death among non-Hispanic Black patients in an age-adjusted analysis (HR, 0.88; 95% CI, 0.58-1.33) or a multivariable analysis (HR, 0.80; 95% CI, 0.56-1.22).

However, among non-Hispanic White patients, there was an association between breast cancer death and living in areas with historical redlining scores of 2.5 or higher in an age-adjusted analysis (HR, 1.31; 95% CI, 0.79-2.18) and a multivariable analysis (HR, 1.28; 95% CI, 0.76-2.14).

Persistent Mortgage Discrimination

The researchers also assessed the impact of persistent mortgage discrimination. Census tracts were classified as experiencing persistent mortgage discrimination if they were historically redlined (score ≥2.5) and experienced contemporary mortgage discrimination.

Non-Hispanic Black patients exposed to persistent mortgage discrimination were more likely to have late-stage disease at diagnosis in an age-adjusted analysis (OR, 4.30; 95% CI, 2.43-7.59) and a multivariable analysis (OR, 3.87; 95% CI, 1.22-6.87). These patients were also more likely to have ER-negative breast cancer in an age-adjusted analysis (OR, 3.30; 95% CI, 2.20-4.95) and a multivariable analysis (OR, 3.10; 95% CI, 2.03-4.61).

Non-Hispanic White patients exposed to persistent mortgage discrimination were more likely to have late-stage disease at diagnosis in an age-adjusted analysis (OR, 3.74; 95% CI, 1.90-7.38) and a multivariable analysis (OR, 3.71; 95% CI, 1.88-6.87). However, there were no significant associations with ER-negative disease.

Non-Hispanic Black patients exposed to persistent mortgage discrimination were more likely to die of breast cancer in an age-adjusted analysis (HR, 3.74; 95% CI, 2.26-6.20) and a multivariable analysis (HR, 1.99; 95% CI, 1.19-3.31).

Non-Hispanic White patients exposed to persistent mortgage discrimination were more likely to die of breast cancer in an age-adjusted analysis (HR, 2.17; 95% CI, 1.13- 4.18) but not a multivariable analysis (HR, 1.45; 95% CI, 0.75-2.80).

“These findings suggest that historical and persistent mortgage discrimination have modern-day implications for breast cancer outcomes,” the researchers concluded.

This article originally appeared on Cancer Therapy Advisor