A recent study conducted across 196 cities has shed light on the enduring impact of historical housing discrimination on colon cancer treatment. Led by S.M. Qasim Hussaini, M.D., from the University of Alabama at Birmingham, in collaboration with colleagues from the American Cancer Society and Johns Hopkins School of Public Health, the findings, published in the journal JCO Oncology Practice, reveal a concerning correlation between past discriminatory housing practices and present-day disparities in colon cancer care.
The study delves into the legacy of the Home Owners’ Loan Corporation (HOLC), a federally sponsored initiative in the 1930s that used racial criteria to determine mortgage loan eligibility. Areas with high Black, immigrant, or minority populations were designated as hazardous for lending, perpetuating systemic disinvestment and socioeconomic inequalities. This discriminatory mapping led to disparities in access to health-promoting resources such as green spaces and healthy foods, particularly in redlined neighbourhoods.
Hussaini and his team analysed data from the National Cancer Database, sourced from 149,917 newly diagnosed colon cancer patients between 2007 and 2017, to assess the impact of historical redlining on contemporary colon cancer care. By correlating patients’ residential locations with HOLC mapping areas, the researchers found that individuals residing in previously redlined areas (HOLC D) were more likely to face advanced-stage diagnosis, delayed treatment, and poorer survival outcomes.
The study highlights stark contrasts between residents of HOLC D areas and those in areas deemed more favourable for mortgage lending (HOLC A). Those in HOLC D areas were significantly more likely to be diagnosed with late-stage colon cancer and less likely to receive guideline-concordant care, including surgery, lymph node evaluation, and chemotherapy. Moreover, residents in HOLC D areas experienced longer wait times for adjuvant chemotherapy, which is crucial for preventing cancer recurrence.
Statistical models revealed a notable excess risk of death for colon cancer patients in HOLC C and HOLC D areas, even after adjusting for cancer stage at diagnosis. These findings underscore the pervasive impact of historical housing discrimination on present-day health outcomes, highlighting the urgent need for addressing systemic inequalities in access to quality cancer care.
This groundbreaking study expands our understanding of the intersection between institutional racism and healthcare disparities, providing valuable insights into the enduring effects of past discriminatory practices on contemporary health outcomes. By elucidating the link between historical redlining and disparities in colon cancer treatment, the research underscores the imperative of promoting health equity and addressing systemic injustices within healthcare systems.
The findings have significant implications for healthcare policy and practice, calling for targeted interventions to mitigate disparities in colon cancer care and improve outcomes for underserved communities. By acknowledging and addressing the legacy of housing discrimination, healthcare providers and policymakers can work towards creating more equitable and accessible healthcare systems, ensuring that all individuals receive the quality care they deserve, regardless of their residential history.
This study powerfully reminds us of the long-lasting impact of historical injustices on present-day health outcomes, emphasising the importance of addressing structural inequalities in healthcare to achieve health equity for all.
More information: S.M. Qasim Hussaini, et al, Association of Historical Housing Discrimination and Colon Cancer Treatment and Outcomes in the United States, JCO Oncology Practice. DOI: 10.1200/OP.23.00426
Journal information: JCO Oncology Practice Provided by The University of Alabama at Birmingham
