A decades-old housing policy that discriminated against minorities could be why some neighborhoods in the US have a higher rate of death from cancer than others.
In a new study, researchers analyzed five- and 10-year cancer survival data in people under 40 and compared rates between people who lived in redlined neighborhoods and those who lived outside of those zones in the US.
Redline neighborhoods date back to the 1920s and 1930s when a government-backed agency deemed a residential area undesirable because of its ethnic demographics.
This practice prevented Black and other minorities from obtaining mortgage loans and buying property in those areas. In turn, this led to segregation and limited funding for hospitals and healthcare accessibility.
Previous research has linked redlining to overall poor health and increased risk of cancer and mortality, but little is known how the practice has specifically affected young or pediatric cancer patients.
In a study published this week, researchers at the University of Washington analyzed survival rate data for 4,355 Washington state residents under 40 diagnosed with different cancers from 2000 to 2019.
Results showed those living in formerly redlined areas had a 32 percent higher risk of death from cancer compared to those living in non-redlined neighborhoods.
Dr Kristine Karvonen, the researcher behind the study, said this was due to ‘racism’ that had prevented non-white people from accessing financial resources to improve their local areas.
SEATTLE: The above map shows the districts of Seattle that were redlined
The above shows how New York City’s Manhattan was divided by the redlining system. The East Village and parts of the Upper East Side were among those to be redlined
Even accounting for other factors, like sex and cancer stage, researchers found for the five-year survival rate, 85 percent of patients living in redlined areas were still alive five years after diagnosis — compared to 90 percent of those in non-redlined areas.
For the 10-year survival rate, 81 percent of redline residents were surviving, compared to 88 percent of other residents.
Redline neighborhoods were borne from a US-government sponsored organization Home Owners’ Loan Corporation (HOLC) that split major cities into zones in the 1920 and 1930s based on what officials believed was the likelihood that residents would pay back a loan.
The organization said their maps were based on consultations with local bank loan officers, city officials and realtors, as well as examinations of factors like house prices in the local area.
But documents from the organization also show they considered the ethnic make-up of communities in their recommendations, cataloging ‘detrimental influences’ such as ‘infiltration of negroes.’
Areas were labeled in descending order from A to D, corresponding to ‘Best’, ‘Still Desirable’, ‘Declining’ and ‘Hazardous’, with studies later showing this was largely based on an area’s demographic.
DETROIT: The above shows how Detroit was divided into zones determining desirability for offering loans
This led to many black- or Hispanic-majority communities being ‘redlined’, or marked as undesirable, leading banks to be less likely to offer loans to residents compared to those in ‘more desirable’ communities.
In turn, redline communities were also less likely to have funding for hospitals or access to healthcare.
The maps were used to determine who to give loans to for decades, until the 1968 Fair Housing Act outlawed racially motivated lending and tasked federal authorities to enforce this — amid the civil rights movement.
Previous research has shown adults living in redlined districts have a 60 percent higher risk of death from breast cancer, and a higher overall risk of premature death.
But in the new study, published in the journal Cancer, researchers examined cancer survival rates among people under 40 living in areas that had previously been redlined.
In the paper, which researchers say is the first to look at this in young patients, they analyzed data from the Cancer Surveillance System — Washington state’s own system for tracking cancer.
CHICAGO: This map shows how most of central Chicago was redlined
TACOMA, WASHINGTON: The above shows the areas of Tacoma in Washington state that were redlined
Patients were from Seattle and Tacoma – parts of which had previously been redlined.
Overall, the study included 411 children aged up to 17 years old, and 3,900 aged 18 to 39 years old. The average age at diagnosis was 32 years.
Among the group, melanoma was the most common cancer — diagnosed in 661 people or 15 percent of the total.
Breast cancer was the second most common, diagnosed in 533 patients, and thyroid cancer was the third most common, diagnosed in 530 patients.
Other cancers included were blood cancers, head and neck cancers, colon cancer and cancers of the urinary tract.
Results were adjusted for factors including age at diagnosis, sex, ethnicity, cancer type and cancer stage.
Data also showed cancers may be less likely to be detected early in those living in redlined areas compared to those living in other areas, which may be linked to a lack of health insurance or access to healthcare — leading someone to put off having a worrying symptom checked.
In non-redlined areas, 57 percent of patients had their cancer diagnosed at stage 1 while 18 percent had their cancer diagnosed at stage 4.
For comparison, in formerly redlined areas, 52 percent of patients had their cancers diagnosed at stage 1 while 22 percent had them diagnosed at stage 4.
Cancers are much harder to treat at stage four because they are more advanced and have spread in the body, which could contribute to the higher death rate.
Dr Karvonen, the pediatrician who led the study, said: ‘This study agrees with previous research that living in an area that was previously redlined nearly a century ago is associated with poor outcomes for patients with cancer today and adds young patients with cancer as a population at risk.
‘Therefore, our study names racism as a potential driver of outcomes for young patients with cancer.’
The study adds: ‘In addition to adverse socioeconomic consequences, serious health issues including higher cancer mortality have been documented for those living in redlined areas.
‘It is plausible that redlining and its downstream mechanisms, such as poor access to healthcare and poverty that drive disparities in adults with cancer, [also] apply to children and young adults.’
