Contemporary neighborhood redlining and racial mortgage lending bias and disparities in prostate cancer survival.

Abstract

Mortgage lending bias is a critical driver of residential segregation, and may contribute to disparities in cancer survival. This study investigated the association between contemporary redlining and racial lending bias and prostate cancer survival. This cohort study used a Surveillance, Epidemiology, and End Results-Medicare database that included 34,163 Black and White men diagnosed with prostate cancer between 2010 and 2013. Home Mortgage Disclosure Act data were used to calculate the census-tract redlining index (the systematic denial of mortgages based on property location) and racial lending bias index (the systematic denial of a mortgage application for a Black applicant compared with a White applicant in the local area). Both indices were assessed continuously and categorically (low, moderate, or high). Multivariable-adjusted Cox models were used to estimate hazard ratios (HRs) for prostate cancer-specific and all-cause mortality. Overall, as the redlining index increased, men experienced poorer prostate cancer survival. Compared to men residing in low-redlined neighborhoods, those in high-redlined neighborhoods had an increased risk of prostate cancer-specific mortality (HR, 1.21; 95% confidence interval [CI], 1.03-1.42) and all-cause mortality (HR, 1.25; 95% CI, 1.17-1.34). Similar results were observed for redlining in a race-stratified analysis among Black and White men. Among White men, compared with those residing in low racial lending bias neighborhoods, those in high racial lending bias neighborhoods had an increased all-cause mortality risk (HR, 1.11; 95% CI, 1.03-1.21). Contemporary redlining was associated with poorer prostate cancer survival in the overall population. However, an association between racial lending bias and elevated mortality was only observed among White men. Findings suggest that mortgage lending discrimination may contribute to disparities in prostate cancer survival.