ASPO Abstracts
Historical housing discrimination, indicators of disinvestment, and breast cancer outcomes nearly a century later
Category: Cancer Health Disparities
Conference Year: 2021
Abstract Body:
Purpose: We investigated associations between 1930's era records of mortgage lending discrimination (i.e., "redliningâ€), a present-day indicator of disinvestment (i.e., residential
physical disorder), and tumor clinicopathologic features (stage, grade, subtype) and survival among women diagnosed with breast cancer in New Jersey.
Methods: Historical, Home Owners' Loan Corporation (HOLC) data were recently geocoded from the University of Richmond's Digital Scholarship Lab. Risk grades of ‘A'/‘Best',
‘B'/‘Still Desirable', ‘C'/‘Definitely Declining', and ‘D'/‘Hazardous' – available for six metropolitan areas of New Jersey – were collapsed into C/D (‘redlined') and A/B (‘not redlined') for
analyses. Sociodemographics (age, race, ethnicity, geocoded residential address, date of diagnosis), tumor features (stage at diagnosis, grade, subtype), and vital status (cause
and date of death) were ascertained from the New Jersey State Cancer Registry for all primary, histologically-confirmed, invasive breast cancer cases diagnosed between 2008 and
2017, among female residents of a HOLC-graded area, who were ≥ 20 years at diagnosis (N=11,980). Residential physical disorder was estimated based on residential address at
diagnosis using spatial prediction models of virtually audited Google Street View scenes of 6,132 locations. Logistic regression models of tumor features and accelerated failure time
models of survival time to BrCa-specific death (follow-up through 2019) were built to investigate associations with redlining and physical disorder, while controlling for covariates.
Results: There were 1,215 BrCa-specific deaths, a median follow-up time of 5.1 years, and a 5-year survival of 89.6%. Living in a historically redlined neighborhood was associated
with higher odds of late-stage and high-grade tumors. Living in a non-redlined neighborhood was associated with a 47.5% (95% CI: 20.1, 79.8) longer survival time in low physical
disorder areas. This survival benefit decreased as physical disorder increased.
Conclusions: Historical racial housing discrimination might interact with present-day measures of disinvestment to influence BrCa survival. Future studies should collect more
comprehensive data including potential confounders and residential history.
Keywords: Historical structural racism, community disinvestment, breast cancer outcomes