Kristine A Karvonen, Annie Vu, Katherine Lin, Joseph Gibbons, Jason A Mendoza, Eric J Chow, Lena E Winestone, Scarlett L Gomez
{"title":"Historical redlining and mortality in children, adolescents, and young adults with cancer in California, 2000-2019.","authors":"Kristine A Karvonen, Annie Vu, Katherine Lin, Joseph Gibbons, Jason A Mendoza, Eric J Chow, Lena E Winestone, Scarlett L Gomez","doi":"10.1093/jnci/djaf105","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Historical redlining, or the Home Owners Loan Corporation (HOLC) program's racially biased mortgage risk monitoring maps in the 1930s, is implicated in shaping modern neighborhoods and health outcomes. This retrospective cohort study evaluates the association between redlining and mortality in young cancer patients.</p><p><strong>Methods: </strong>Using the California Cancer Registry, we identified patients <25 years old diagnosed with malignant cancer between 2000-2019. HOLC maps were spatially joined with patient address at diagnosis to determine redlining status (A \"Best\", B \"Still Desirable\", C \"Declining\", D \"Hazardous\"). Census tract-level U.S. Census and American Community Survey data were appended to determine modern neighborhood characteristics. The Kaplan-Meier method was used to evaluate overall survival and multivariable Cox proportional hazards models to estimate the associations between HOLC grade and mortality, adjusting for clinical and multilevel social drivers of health.</p><p><strong>Results: </strong>In total 8,108 patients resided in HOLC-graded neighborhoods among 51,084 patients statewide. Overall survival at 5 years was inferior for patients who resided in D graded neighborhoods at diagnosis vs A graded neighborhoods (80.3%, 95% CI: 78.6-81.8 vs 88.5%, 95% CI: 84.3-91.6). Adjusting for clinical characteristics, patients in D graded neighborhoods experienced greater mortality (HR 1.32, 95% CI: 1.12-1.56) compared with those in A and B graded neighborhoods. Additional adjustment for insurance attenuated the effect (HR 1.17, 95%CI: 1.00-1.36) and for neighborhood socioeconomic status marginally attenuated the effect (HR 0.96, 95% CI: 0.81-1.13).</p><p><strong>Conclusion: </strong>Findings suggest enduring legacy effects of historical redlining on young individuals with cancer, potentially mediated social factors including health insurance.</p>","PeriodicalId":14809,"journal":{"name":"JNCI Journal of the National Cancer Institute","volume":" ","pages":""},"PeriodicalIF":9.9000,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JNCI Journal of the National Cancer Institute","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/jnci/djaf105","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Historical redlining, or the Home Owners Loan Corporation (HOLC) program's racially biased mortgage risk monitoring maps in the 1930s, is implicated in shaping modern neighborhoods and health outcomes. This retrospective cohort study evaluates the association between redlining and mortality in young cancer patients.
Methods: Using the California Cancer Registry, we identified patients <25 years old diagnosed with malignant cancer between 2000-2019. HOLC maps were spatially joined with patient address at diagnosis to determine redlining status (A "Best", B "Still Desirable", C "Declining", D "Hazardous"). Census tract-level U.S. Census and American Community Survey data were appended to determine modern neighborhood characteristics. The Kaplan-Meier method was used to evaluate overall survival and multivariable Cox proportional hazards models to estimate the associations between HOLC grade and mortality, adjusting for clinical and multilevel social drivers of health.
Results: In total 8,108 patients resided in HOLC-graded neighborhoods among 51,084 patients statewide. Overall survival at 5 years was inferior for patients who resided in D graded neighborhoods at diagnosis vs A graded neighborhoods (80.3%, 95% CI: 78.6-81.8 vs 88.5%, 95% CI: 84.3-91.6). Adjusting for clinical characteristics, patients in D graded neighborhoods experienced greater mortality (HR 1.32, 95% CI: 1.12-1.56) compared with those in A and B graded neighborhoods. Additional adjustment for insurance attenuated the effect (HR 1.17, 95%CI: 1.00-1.36) and for neighborhood socioeconomic status marginally attenuated the effect (HR 0.96, 95% CI: 0.81-1.13).
Conclusion: Findings suggest enduring legacy effects of historical redlining on young individuals with cancer, potentially mediated social factors including health insurance.
期刊介绍：
The Journal of the National Cancer Institute is a reputable publication that undergoes a peer-review process. It is available in both print (ISSN: 0027-8874) and online (ISSN: 1460-2105) formats, with 12 issues released annually. The journal's primary aim is to disseminate innovative and important discoveries in the field of cancer research, with specific emphasis on clinical, epidemiologic, behavioral, and health outcomes studies. Authors are encouraged to submit reviews, minireviews, and commentaries. The journal ensures that submitted manuscripts undergo a rigorous and expedited review to publish scientifically and medically significant findings in a timely manner.
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