ArticleCancer medicine2024
Association of area-level mortgage denial and guideline-concordant non-small-cell lung cancer care and outcomes in the United States.
Article in Cancer medicine, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- Machine learning-based mapping of multimodal treatment allocations and prognostic implications of clinical concordance in non-small cell lung cancer.Scientific reports · 2026Article
- The association of contemporary mortgage lending bias and receipt of guideline-concordant systemic treatment among older women with breast cancer.Breast cancer research and treatment · 2025Article
- Contemporary Area-Level Mortgage Loan Denial Risk and Health-Related Quality of Life Among Cancer Survivors.Cancer medicine · 2025Article
- Ongoing Failure to Deliver Guideline-Concordant Care for Patients with Pancreatic Cancer.Cancers · 2025Article
- Social and Legal Needs in Patients and Families With Cancer: Interaction With Patient-Level Financial Toxicity.JCO oncology practice · 2025Review
- Association of area-level mortgage denial and guideline-concordant non-small-cell lung cancer care and outcomes in the United States.Cancer medicine · 2024Article
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Authors and funding
7 authors.
Funding
Abstract
backgroundRacial and socioeconomic disparities in receipt of care for non-small-cell lung cancer (NSCLC) are well described. However, no previous studies have evaluated the association between mortgage denial rates and receipt of timely and guideline-concordant care for NSCLC and patient outcomes.
methodsWe identified individuals ≥18 years diagnosed with NSCLC between 2014 and 2019 from the National Cancer Database. Using the Home Mortgage Disclosure Act database, we calculated the proportion of denied home loans to total loans at the zip-code level and categorized them into quintiles. Our outcomes included receipt of guideline-concordant care based on clinical and pathologic stage at diagnosis and the National Comprehensive Cancer Network guidelines, time from surgery to chemotherapy initiation, and overall survival.
resultsOf the 629,288 individuals diagnosed with NSCLC (median age 69; IQR 61-76 years, 49.1% female), 47.8% did not receive guideline-concordant care. Residing in areas with higher mortgage denial rates and lower income was associated with worse guideline-concordant care overall (aRR = 1.28; 95% CI = 1.25-1.32) and for each cancer treatment modality, worse receipt of timely chemotherapy (aHR = 1.14; 95% CI = 1.11-1.17) and worse overall survival (aHR = 1.21; 95% CI = 1.19-1.22), compared with residing in areas with the lowest mortgage denial rate and highest income.
conclusionsArea-level mortgage denial rate was associated with worse receipt of timely and guideline-concordant NSCLC care and survival. This highlights the critical need to understand and address systemic practices, such as mortgage denial, that limit access to resources and are associated with worse access to quality cancer care and outcomes.
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