ArticleAnnals of surgical oncology2025
Impact of Contemporary Redlining on Healthcare Disparities Among Patients with Gastrointestinal Cancer: A Mediation Analysis.
Article in Annals of surgical oncology, 2025. 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.
- Historical redlining, breast cancer survival, and the mediating and modifying role of contemporary neighborhood socioeconomic conditions.American journal of epidemiology · 2026Article
- Understanding financial toxicity in cancer care through a social-ecological lens.Current opinion in oncology · 2026Review
- 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
- Living in historically redlined neighborhoods and biological aging among older adults.The journals of gerontology. Series A, Biological sciences and medical sciences · 2025Article
- State-Level Tax Policy, Cancer Screening, and Mortality Rates in the US.JAMA network open · 2025Article
- Distribution of pharmacy deserts and its association with digital divide and residential redlining across the United States.PloS one · 2025Article
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8 authors.
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Abstract
backgroundHistorically, housing policies have perpetuated the marginalization and economic disinvestment of redlined neighborhoods. Residential segregation persists nowadays in the form of contemporary redlining, promoting healthcare disparities. The current study sought to assess the effect of redlining on oncological outcomes of patients with gastrointestinal cancer and identify mediators of the association.
methodsPatients with colorectal or hepatobiliary cancer were identified from the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database (2007-2019). The contemporary redlining index, a measure of mortgage lending bias, was assessed relative to disease stage at diagnosis, receipt of appropriate treatment, textbook outcome, and mortality. Mediation analysis was used to identify socioeconomic, structural, and clinical mediating factors.
resultsAmong 94,988 patients, 32.2% resided in high (n = 23,872) and highest (n = 6,791) redlining census tracts compared with 46.2% in neutral and 21.6% in low redlining tracts. The proportion of Black, Hispanic, and White patients experiencing high and highest redlining was 65.9%, 41.6%, and 27.9%, respectively. Highest redlining was associated with 18.2% higher odds of advanced disease at diagnosis, greater odds of not undergoing surgery for localized disease (adjusted odds ratio [aOR] 1.363, 95% confidence interval [CI] 1.219-1.524) or not receiving chemotherapy for advanced disease (aOR 1.385, 95% CI 1.216-1.577), and 26.7% lower odds of textbook outcome achievement. Mediation analysis for appropriate treatment quantified the proportion of the association driven by socioeconomic status, racial/ethnic minority status, racial/economic segregation, primary care shortage, and housing/transportation.
conclusionsContemporary redlining contributed both directly, and via downstream factors, to disparities in oncological care and outcomes of patients with gastrointestinal cancer.
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