Housing Discrimination, Residential Racial Segregation, and Colorectal Cancer Survival in Southeastern Wisconsin

Abstract

Residential racial segregation is still neglected in contemporary examinations of racial health disparities, including studies of cancer. Even fewer studies examine the processes by which segregation occurs, such as through housing discrimination. This study aims to examine relationships among housing discrimination, segregation, and colorectal cancer survival in southeastern Wisconsin. Cancer incidence data were obtained from the Wisconsin Cancer Reporting System for two southeastern Wisconsin metropolitan areas. Two indices of mortgage discrimination were derived from Home Mortgage Disclosure Act data, and a measure of segregation (the location quotient) was calculated from U.S. census data; all predictors were specified at the ZIP Code Tabulation Area level. Cox proportional hazards regression was used to examine associations between mortgage discrimination, segregation, and colorectal cancer survival in southeastern Wisconsin. For all-cause mortality, racial bias in mortgage lending was significantly associated with a greater hazard rate among blacks [HR = 1.37; 95% confidence interval (CI), 1.06-1.76] and among black women (HR = 1.53; 95% CI, 1.06-2.21), but not black men in sex-specific models. No associations were identified for redlining or the location quotient. Additional work is needed to determine whether these findings can be replicated in other geographical settings. Our findings indicate that black women in particular experience poorer colorectal cancer survival in neighborhoods characterized by racial bias in mortgage lending, a measure of institutional racism. These findings are in line with previous studies of breast cancer survival. Housing discrimination and institutional racism may be important targets for policy change to reduce health disparities, including cancer disparities.

Housing discrimination and racial cancer disparities among the 100 largest US metropolitan areas

“…Measures of segregation are inconsistently associated with cancer disparities, although black men living in areas with greater isolation experience significantly greater cancer incidence and mortality. 13,24 We did not find segregation to be consistently associated with cancer disparities. 18,19 Our findings suggest that cancer incidence, mortality, and survival disparities warrant attention.…”

“…22,23 Only two small, local studies have previously related biased mortgage lending to cancer outcomes. 13,24 We did not find segregation to be consistently associated with cancer disparities. A few prior studies have related segregation to site-specific cancer disparities nationally, with mixed results.…”

Geospatial approaches to cancer control and population sciences at the United States cancer centers

“…The articles coalesced around two primary themes that may help guide future geospatial cancer research: health disparities and novel operational definitions of the environment. Geospatial research for cancer control can contribute to describing existing and emerging cancer disparities and elucidating their underlying causes; for example, several papers highlighted the importance of residential segregation as a correlate of observed disparate cancer outcomes [27, 33, 34]. Additionally, etiologic and intervention studies could benefit from innovative environmental metrics such as measures of zoning or “green” environmental elements, as well as from gathering more comprehensive residential histories [2, 35, 36].…”

Ethnic density and cancer: A review of the evidence

“…7,55 Two studies reported no association with mortality. 52,56 Finally, in 2 lung cancer studies, higher segregation was associated with greater mortality among blacks, but not among whites. 44,53 Findings are less consistent across the 11 studies that examined Hispanic ethnic density.…”

“…Three studies used the location quotient as a local index of segregation. [54][55][56] Below, the empirical studies included in this review are grouped according to whether they addressed cancer 12 Linder 2008, 13 Wilson 2015, 14 Amey 1997, 15 Reyes-Ortiz 2008, 16 Harvey 2017, 17 Parsons & Askland, 2007 18,19 Russell 2011Russell , 2012 Lim & Ashing-Giwa, 2011 22 Pruitt 2016 23 % Recent immigrants or foreign-born Census block-group, tract "Recency" not always defined, but sometimes defined as within last 5 y…”