Historical redlining and mortality in children, adolescents, and young adults with cancer in California, 2000-2019

Historical redlining, or the Home Owners' Loan Corporation (HOLC) program's racially biased mortgage risk monitoring maps in the 1930s, is implicated in shaping modern neighborhoods and health outcomes. This retrospective cohort study evaluates the association between redlining and mortali...

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Bibliographic Details
Published in:JNCI : Journal of the National Cancer Institute Vol. 117; no. 8; p. 1646
Main Authors: Karvonen, Kristine A, Vu, Annie, Lin, Katherine, Gibbons, Joseph, Mendoza, Jason A, Chow, Eric J, Winestone, Lena E, Gomez, Scarlett L
Format: Journal Article
Language:English
Published: United States 01.08.2025
Subjects:
Adolescent
Adult
California - epidemiology
Child
Child, Preschool
Female
Humans
Infant
Male
Neighborhood Characteristics - statistics & numerical data
Neoplasms - epidemiology
Neoplasms - mortality
Registries - statistics & numerical data
Residence Characteristics - statistics & numerical data
Retrospective Studies
Socioeconomic Factors
Young Adult
California
ISSN:1460-2105, 1460-2105
Online Access:Get more information
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Summary:Historical redlining, or the Home Owners' Loan Corporation (HOLC) program's racially biased mortgage risk monitoring maps in the 1930s, is implicated in shaping modern neighborhoods and health outcomes. This retrospective cohort study evaluates the association between redlining and mortality in young cancer patients. Using the California Cancer Registry, we identified patients aged younger than 25 years diagnosed with malignant cancer between 2000 and 2019. HOLC maps were spatially joined with patient address at diagnosis to determine redlining status (A [best], B [still desirable], C [declining], D [hazardous]). Census tract-level US Census and American Community Survey data were appended to determine modern neighborhood characteristics. The Kaplan-Meier method was used to evaluate overall survival and multivariable Cox proportional hazards models to estimate the associations between HOLC grade and mortality, adjusting for clinical and multilevel social drivers of health. In total, 8108 patients resided in HOLC-graded neighborhoods among 51 084 patients statewide. Overall survival at 5 years was inferior for patients who resided in D-graded neighborhoods at diagnosis vs A-graded neighborhoods (80.3%, 95% confidence interval [CI] = 78.6% to 81.8%, vs 88.5%, 95% CI = 84.3% to 91.6%). Adjusting for clinical characteristics, patients in D-graded neighborhoods experienced greater mortality (hazard ratio [HR] = 1.32, 95% CI = 1.12 to 1.56) compared with those in A- and B-graded neighborhoods. Additional adjustment for insurance attenuated the effect (HR = 1.17, 95% CI = 1.00 to 1.36), and for neighborhood, socioeconomic status marginally attenuated the effect (HR = 0.96, 95% CI = 0.81 to 1.13). Findings suggest enduring legacy effects of historical redlining on young individuals with cancer potentially mediated social factors, including health insurance.
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ISSN:1460-2105
1460-2105
DOI:10.1093/jnci/djaf105