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

Abstract

Abstract Background: 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. Methods: 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. Results: 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. Conclusions: 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. Impact: Housing discrimination and institutional racism may be important targets for policy change to reduce health disparities, including cancer disparities. Cancer Epidemiol Biomarkers Prev; 26(4); 561–8. ©2017 AACR. See all the articles in this CEBP Focus section, “Geospatial Approaches to Cancer Control and Population Sciences.”

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