Cancer Stage at Diagnosis, Historical Redlining, and Current Neighborhood Characteristics: Breast, Cervical, Lung, and Colorectal Cancers, Massachusetts, 2001–2015

Abstract In the 1930s, maps created by the federal Home Owners’ Loan Corporation (HOLC) nationalized residential racial segregation via “redlining,” whereby HOLC designated and colored in red areas they deemed to be unsuitable for mortgage lending on account of their Black, foreign-born, or low-inco...

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Published in:American journal of epidemiology Vol. 189; no. 10; pp. 1065 - 1075
Main Authors: Krieger, Nancy, Wright, Emily, Chen, Jarvis T, Waterman, Pamela D, Huntley, Eric R, Arcaya, Mariana
Format: Journal Article
Language:English
Published: Oxford University Press 01.10.2020
Subjects:
lung cancer
stage at diagnosis
colorectal cancer
historical redlining
breast cancer
health inequities
residential segregation
cervical cancer
ISSN:0002-9262, 1476-6256, 1476-6256
Online Access:Get full text
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Summary:Abstract In the 1930s, maps created by the federal Home Owners’ Loan Corporation (HOLC) nationalized residential racial segregation via “redlining,” whereby HOLC designated and colored in red areas they deemed to be unsuitable for mortgage lending on account of their Black, foreign-born, or low-income residents. We used the recently digitized HOLC redlining maps for 28 municipalities in Massachusetts to analyze Massachusetts Cancer Registry data for late stage at diagnosis for cervical, breast, lung, and colorectal cancer (2001–2015). Multivariable analyses indicated that, net of age, sex/gender, and race/ethnicity, residing in a previously HOLC-redlined area imposed an elevated risk for late stage at diagnosis, even for residents of census tracts with present-day economic and racial privilege, whereas the best historical HOLC grade was not protective for residents of census tracts without such current privilege. For example, a substantially elevated risk of late stage at diagnosis occurred among men with lung cancer residing in currently privileged areas that had been redlined (risk ratio = 1.17, 95% confidence interval: 1.06, 1.29), whereas such risk was attenuated among men residing in census tracts lacking such current privilege (risk ratio = 1.01, 95% confidence interval: 0.94, 1.08). Research on historical redlining as a structural driver of health inequities is warranted.
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ISSN:0002-9262
1476-6256
1476-6256
DOI:10.1093/aje/kwaa045