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

Wayne R Lawrence; Neal D Freedman; Jennifer K McGee-Avila; Hyokyoung G Hong; Scarlett L Gomez; Andrew P Loehrer; Kirsten M M Beyer; Yuhong Zhou; Jared W Magnani; Harold W Neighbors; Jarrett A Johnson; Ziqiang Lin; Amy J Davidoff; Adana A M Llanos; Meredith S Shiels

doi:10.1002/cncr.35850

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

Cancer. 2025 Apr 15;131(8):e35850. doi: 10.1002/cncr.35850.

Authors

Wayne R Lawrence¹, Neal D Freedman^{1

2}, Jennifer K McGee-Avila^{1

2}, Hyokyoung G Hong¹, Scarlett L Gomez^{3

4}, Andrew P Loehrer^{5

6

7

8}, Kirsten M M Beyer⁹, Yuhong Zhou⁹, Jared W Magnani¹⁰, Harold W Neighbors¹¹, Jarrett A Johnson¹², Ziqiang Lin¹³, Amy J Davidoff², Adana A M Llanos^{14

15}, Meredith S Shiels¹

Affiliations

¹ Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA.
² Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA.
³ Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA.
⁴ Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA.
⁵ Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.
⁶ Dartmouth Cancer Center, Lebanon, New Hampshire, USA.
⁷ Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA.
⁸ The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA.
⁹ Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
¹⁰ Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
¹¹ Health Behavior and Health Equity, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.
¹² Division of Community Health and Population Science, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA.
¹³ Department of Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China.
¹⁴ Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA.
¹⁵ Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York, USA.

PMID: 40233138
PMCID: PMC12001745 (available on 2026-04-15)
DOI: 10.1002/cncr.35850

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

Keywords: cancer survivorship; economic disparities in health; health inequities; institutional racism; residential segregation; social determinants of health; structural racism.

MeSH terms

Aged
Aged, 80 and over
Black or African American / statistics & numerical data
Health Status Disparities*
Humans
Male
Medicare
Neighborhood Characteristics* / statistics & numerical data
Prostatic Neoplasms* / ethnology
Prostatic Neoplasms* / mortality
Racism* / statistics & numerical data
SEER Program
United States / epidemiology
White / statistics & numerical data

Abstract

MeSH terms

Grants and funding