Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.
Cancer Epidemiol Biomarkers Prev. 2021 Jan;30(1):53-60. doi: 10.1158/1055-9965.EPI-20-1038. Epub 2020 Oct 2.
Structural inequities have important implications for the health of marginalized groups. Neighborhood-level redlining and lending bias represent state-sponsored systems of segregation, potential drivers of adverse health outcomes. We sought to estimate the effect of redlining and lending bias on breast cancer mortality and explore differences by race.
Using Georgia Cancer Registry data, we included 4,943 non-Hispanic White (NHW) and 3,580 non-Hispanic Black (NHB) women with a first primary invasive breast cancer diagnosis in metro-Atlanta (2010-2014). Redlining and lending bias were derived for census tracts using the Home Mortgage Disclosure Act database. We calculated hazard ratios and 95% confidence intervals (CI) for the associations of redlining, lending bias on breast cancer mortality and estimated race-stratified associations.
Overall, 20% of NHW and 80% of NHB women lived in redlined census tracts, and 60% of NHW and 26% of NHB women lived in census tracts with pronounced lending bias. Living in redlined census tracts was associated with a nearly 1.60-fold increase in breast cancer mortality (hazard ratio = 1.58; 95% CI, 1.37-1.82) while residing in areas with substantial lending bias reduced the hazard of breast cancer mortality (hazard ratio = 0.86; 95% CI, 0.75-0.99). Among NHB women living in redlined census tracts, we observed a slight increase in breast cancer mortality (hazard ratio = 1.13; 95% CI, 0.90-1.42); among NHW women the association was more pronounced (hazard ratio = 1.39; 95% CI, 1.09-1.78).
These findings underscore the role of ecologic measures of structural racism on cancer outcomes.
Place-based measures are important contributors to health outcomes, an important unexplored area that offers potential interventions to address disparities.
结构性不平等对边缘化群体的健康有重要影响。社区层面的红线和贷款偏见代表了国家支持的隔离制度，是造成不良健康结果的潜在驱动因素。我们试图估计红线和贷款偏见对乳腺癌死亡率的影响，并探讨种族差异。
我们使用佐治亚州癌症登记处的数据，纳入了亚特兰大都会区（2010-2014 年）首次确诊为浸润性乳腺癌的 4943 名非西班牙裔白人（NHW）和 3580 名非西班牙裔黑人（NHB）女性。使用住房抵押贷款披露法案数据库为普查区计算红线和贷款偏见。我们计算了红线、贷款偏见与乳腺癌死亡率之间关联的风险比和 95%置信区间（CI），并估计了种族分层关联。
总体而言，20%的 NHW 和 80%的 NHB 女性居住在红线普查区，60%的 NHW 和 26%的 NHB 女性居住在贷款偏见显著的普查区。居住在红线普查区与乳腺癌死亡率增加近 1.60 倍相关（风险比=1.58；95%CI，1.37-1.82），而居住在贷款偏见较大的地区则降低了乳腺癌死亡率的风险（风险比=0.86；95%CI，0.75-0.99）。在居住在红线普查区的 NHB 女性中，我们观察到乳腺癌死亡率略有增加（风险比=1.13；95%CI，0.90-1.42）；而在 NHW 女性中，这种关联更为明显（风险比=1.39；95%CI，1.09-1.78）。
这些发现强调了生态性种族主义措施对癌症结果的作用。
基于位置的措施是健康结果的重要贡献者，这是一个尚未被充分探索的重要领域，为解决差异提供了潜在的干预措施。
