Study shows the enduring impact of historical redlining on colon cancer care

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A nationwide study of 196 cities shows that lodging favoritism from 90 years agone still casts a humanities protector of inequities successful colon crab attraction today, S.M. Qasim Hussaini, M.D., of nan University of Alabama astatine Birmingham and colleagues astatine nan American Cancer Society and Johns Hopkins School of Public Health study successful nan diary JCO Oncology Practice.

In nan 1930s, nan federally sponsored Home Owners' Loan Corporation, aliases HOLC, utilized group creation to representation retired residential areas worthy of receiving owe loans and those areas to avoid. Neighborhoods precocious successful Black, migrant aliases number non-white populations were red-lined arsenic hazardous for location loans, creating systemic and persistent disinvestment successful those neighborhoods, on pinch wealthiness inequities and attraction of health-harming exposures and psychosocial stressors. These limitations reduced entree to health-promoting equipment and resources specified arsenic greenish space, parks and patient foods successful redlined neighborhoods.

To trial whether residence successful nan formerly red-lined neighborhoods is associated pinch poorer guideline-concordant crab attraction today, Hussaini and colleagues mapped colon crab attraction for 149,917 recently diagnosed colon crab patients from 2007 done 2017, arsenic elaborate successful nan National Cancer Database, against current-day residence successful 1 of nan 4 humanities HOLC mapping areas. In nan 1930s, nan greenish HOLC areas, aliases HOLC A, were considered champion for owe loans; nan bluish areas, aliases HOLC B, were considered still desirable; nan yellowish areas, aliases HOLC C, were marked arsenic decidedly declining; and nan reddish areas, aliases HOLC D, were flagged arsenic hazardous and to beryllium avoided for owe lending purposes.

Overall, nan researchers recovered that individuals diagnosed pinch colon crab who resided successful antecedently redlined HOLC D areas crossed nan United States were coming much apt to beryllium diagnosed pinch advanced-stage disease, were little apt to person guideline-concordant aliases timely treatment, and had worse survival.

These findings underscore nan agelong protector of organization racism done state- and federal-level discriminatory practices successful shaping entree to high-quality attraction and amended outcomes for colon cancer, which is amenable to early discovery and treatment."

 S.M. Qasim Hussaini, M.D., Assistant Professor, UAB Department of Medicine Division of Hematology and Oncology

In detail, individuals surviving successful HOLC D areas were much apt to beryllium diagnosed pinch late-stage colon crab compared pinch those surviving successful HOLC A areas. Of nan 78,164 group who did not person guideline-concordant attraction arsenic defined by nan National Comprehensive Cancer Network, nan likelihood of receiving non-guideline concordant attraction accrued for individuals domiciled successful areas pinch expanding hazard grades assigned by HOLC B, HOLC C and HOLC D, arsenic compared pinch individuals domiciled successful HOLC A areas.

People surviving successful HOLC D areas were 24 percent much apt to not person guideline-concordant care, 34 percent much apt to not person surgery, 26 percent much apt to not person astatine slightest 12 location lymph nodes evaluated during room for dispersed of nan cancer, and 20 percent much apt to not person chemotherapy, compared pinch group surviving successful HOLC A areas.

A predicted probabilities exemplary -; which adjusts estimates of line non-concordance for property and activity -; showed that non-receipt of guideline-concordant attraction overall, arsenic good arsenic non-receipt of guideline-concordant surgery, lymph node information and chemotherapy, sequentially accrued from nan HOLC A areas done to nan HOLC D areas. Compared pinch those crab patients surviving successful HOLC A areas, those domiciled successful HOLC B, HOLC C and HOLC D areas had accrued hold times to nan commencement of adjuvant chemotherapy. Adjuvant chemotherapy is fixed aft room successful bid to termination immoderate remaining crab cells and trim nan chance of illness recurrence.

Compared pinch recently diagnosed colon crab patients domiciled successful HOLC A areas, those surviving HOLC C and D areas had 9 percent and 13 percent excess consequence of decease successful statistical models that did not set for shape of nan crab astatine clip of diagnosis. After stratification by shape -; either early, stages I and II, aliases advanced, stages III and IV -; nan excess consequence of decease relation persisted for nan HOLC C and HOLC D areas for some nan early and precocious stages astatine diagnosis.

Several erstwhile studies by others person noted group aliases taste disparities successful bosom crab outcomes successful antecedently redlined neighborhoods successful New Jersey, an accrued incidence of advanced-stage lung crab successful formerly redlined areas of Massachusetts and a little likelihood of lung crab screening for Black individuals successful antecedently redlined areas of Boston. However, those azygous geographic area studies did not analyse whether patients received value crab care.

"To our knowledge, this is nan first nationalist study, including each states, to measure nan relation betwixt humanities organization racism and current-day receipt of value crab attraction and outcomes utilizing standardized measures of crab diagnosis, individual and tumor characteristics, receipt of treatment, and survival," Hussaini said. "Other strengths of nan study are a divers study organization including each property and group groups, and a attraction connected aggregate aspects of attraction from shape astatine test to curen receipt and survival."

The American Society of Clinical Oncology, aliases ASCO, defines wellness equity arsenic a adjacent and conscionable opportunity for everyone to beryllium arsenic patient arsenic possible. Colon crab has astir 150,000 caller cases each year. It is nan 3rd astir diagnosed crab successful nan United States and nan 2nd starring origin of decease from cancer, moreover though colon crab is amenable to early discovery and treatment. Widespread inequities successful endurance beryllium owed to unequal entree to care.

Co-authors pinch Hussaini successful nan study, "Association of humanities lodging favoritism and colon crab curen and outcomes successful nan United States," are Qinjin Fan, K. Robin Yabroff and Leticia M. Nogueira, nan American Cancer Society, Atlanta, Georgia; and Lauren C.J. Barrow and Craig E. Pollack, Johns Hopkins University, Baltimore, Maryland.

Support came from National Institutes of Health SEER-Medicare HOMES assistance CA269488, National Institutes of Health assistance CA269488 and ASCO Young Investigator Award 2023YIA-5973930875. This study was antecedently presented, successful part, astatine nan 2022 ASCO Quality Symposium successful Chicago, Illinois.

At UAB, Medicine is simply a section successful nan Marnix E. Heersink School of Medicine, and Hussaini is besides an subordinate intelligence successful nan O'Neal Comprehensive Cancer Center. Hussaini completed his aesculapian oncology fellowship astatine Johns Hopkins Hospital, Baltimore, Maryland.


Journal reference:

Qasim Hussaini, S.M., et al. (2024). Association of Historical Housing Discrimination and Colon Cancer Treatment and Outcomes successful nan United States. JCO Oncology Practice.