O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL.
Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, MD.
JCO Oncol Pract. 2024 May;20(5):678-687. doi: 10.1200/OP.23.00426. Epub 2024 Feb 6.
In the 1930s, the federally sponsored Home Owners' Loan Corporation (HOLC) used racial composition in its assessment of areas worthy of receiving loans. Neighborhoods with large proportions of Black residents were mapped in red (ie, redlining) and flagged as hazardous for mortgage financing. Redlining created a platform for systemic disinvestment in these neighborhoods, leading to barriers in access to resources that persist today. We investigated the association between residing in areas with different HOLC ratings and receipt of quality cancer care and outcomes among individuals diagnosed with colon cancer-a leading cause of cancer deaths amenable to early detection and treatment.
Individuals who resided in zip code tabulation areas in 196 cities with HOLC rating and were diagnosed with colon cancer from 2007 to 2017 were identified from the National Cancer Database and assigned a HOLC grade (A, best; B, still desirable; C, definitely declining; and D, hazardous and mapped in red). Multivariable logistic regression models investigated association of area-level HOLC grade and late stage at diagnosis and receipt of guideline-concordant care. The product-limit method evaluated differences in time to adjuvant chemotherapy. Multivariable Cox proportional hazard models investigated differences in overall survival (OS).
There were 149,917 patients newly diagnosed with colon cancer with a median age of 68 years. Compared with people living in HOLC A areas, people living in HOLC D areas were more likely to be diagnosed with late-stage disease (adjusted odds ratio, 1.06 [95% CI, 1.00 to 1.12]). In addition, people living in HOLC B, C, and D areas had 8%, 16%, and 24% higher odds of not receiving guideline-concordant care, including lower receipt of surgery, evaluation of ≥12 lymph nodes, and chemotherapy. People residing in HOLC B, C, or D areas also experienced delays in initiation of adjuvant chemotherapy after surgery. People residing in HOLC C (adjusted hazard ratio [aHR], 1.09 [95% CI, 1.05 to 1.13]) and D (aHR, 1.13 [95% CI, 1.09 to 1.18]) areas had worse OS, including 13% and 20% excess risk of death for individuals diagnosed with early- and 6% and 8% for late-stage disease for HOLC C and D, respectively.
Historical housing discrimination is associated with worse contemporary access to colon cancer care and outcomes.
在 20 世纪 30 年代，联邦政府赞助的房主贷款公司（HOLC）在评估有资格获得贷款的地区时，使用了种族构成。黑人居民比例较大的社区被标记为红色（即“红线”），被标记为抵押贷款融资的危险区域。红线划定为这些社区系统性撤资的平台，导致至今仍存在获得资源的障碍。我们调查了居住在不同 HOLC 评级地区与接受结肠癌优质癌症护理和结局之间的关联，结肠癌是一种早期发现和治疗可导致死亡的主要癌症。
从国家癌症数据库中确定了 196 个城市的邮政编码区域中居住的、2007 年至 2017 年期间被诊断患有结肠癌的个人，并根据 HOLC 等级（A，最佳；B，仍然可取；C，肯定下降；D，危险且标记为红色）进行了分配。多变量逻辑回归模型调查了区域 HOLC 等级和诊断时晚期阶段以及接受指南一致的护理之间的关联。产品限制法评估了辅助化疗时间的差异。多变量 Cox 比例风险模型调查了总体生存率（OS）的差异。
有 149917 例新诊断的结肠癌患者，中位年龄为 68 岁。与居住在 HOLC A 区的人相比，居住在 HOLC D 区的人更有可能被诊断为晚期疾病（调整后的优势比，1.06[95%CI，1.00 至 1.12]）。此外，居住在 HOLC B、C 和 D 区的人接受指南一致的护理的可能性分别降低了 8%、16%和 24%，包括手术、评估≥12 个淋巴结和化疗的可能性降低。接受手术后，居住在 HOLC B、C 或 D 区的人开始接受辅助化疗的时间也有所延迟。居住在 HOLC C（调整后的危险比[aHR]，1.09[95%CI，1.05 至 1.13]）和 D（aHR，1.13[95%CI，1.09 至 1.18]）区的人 OS 较差，包括早期诊断的人死亡风险增加 13%和 20%，晚期诊断的人死亡风险增加 6%和 8%。
历史住房歧视与结肠癌护理和结局的当代不良获得有关。
