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-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.

Redlines and Greenspace: The Relationship between Historical Redlining and 2010 Greenspace across the United States

“…Historical redlining maps were real estate appraisal tools that reflected institutional forms of discrimination endorsed and perpetuated by those considered experts in the effort to stabilize the real estate market during the Great Depression. Mounting evidence indicates that these historical HOLC risk grade maps contribute to current patterns of worse health outcomes among modern neighborhoods ( Krieger et al. 2020 ; Nardone et al.…”

The Intersection of Rural Residence and Minority Race/Ethnicity in Cancer Disparities in the United States

“…Jim Crow laws were state and local regulations commonly found in the South that codified racial segregation in transportation, employment, restaurants, and other settings [ 46 ]. Similarly, in urban areas, living in a historically “redlined” area is associated with later stage at diagnosis and poorer cancer survival [ 47 ]. “Redlining” was another form of government-sponsored segregation that essentially prevented individuals in Black communities from successfully obtaining mortgages [ 47 ].…”

Associations between historical redlining and birth outcomes from 2006 through 2015 in California

“…Though HOLC did not always lend in accordance with Security Map risk grades, HOLC lending did reinforce pre-existing racial segregation; moreover, the legacy of HOLC risk grades are associated with current patterns of neighborhood racial residential segregation, poverty, income inequality, tree canopy coverage, higher ambient temperatures, diesel particulate emissions, and diminished home value appreciation [ 13 – 19 ]. As the practice of redlining segregated and deprived certain communities of investment and opportunities for wealth accumulation through homeownership, it is possible that such policies structured these neighborhoods in ways that affect current health outcomes [ 17 , 19 – 22 ]. Ecosocial Theory, developed by Krieger et al ., provides a theoretical framework for understanding how redlining and other complimentary racist policies undermine community health.…”