Historical redlining and survival among children, adolescents, and young adults with cancer diagnosed between 2000–2019 in Seattle and Tacoma, Washington

Background

Historical redlining has been associated with inferior survival in adult-onset cancers. However, its relationship with pediatric, adolescent, and young–adult-onset cancer outcomes is unknown.

Methods

This study identified incident cancer among individuals <40 years of age living in Seattle and Tacoma between 2000–2019 via the population-based Cancer Surveillance System. The authors determined case redlining status using Home Owners’ Loans Corporation data overlaid with 2000 and 2010 census tracts. Kaplan–Meier methods and multivariable Cox proportional hazards models were used to determine 5- and 10-year overall survival and hazard ratio (HR) of death according to redlined status. Cox models adjusted for patient and tumor characteristics and area-level poverty; interaction between redlining and area-level poverty was also assessed.

Results

Among 4355 cases (median age at diagnosis 32 years), overall survival at 5 years was lower (85.1%; 95% confidence interval [CI], 83.5%–86.5%) among individuals residing in redlined neighborhoods compared with those in unexposed neighborhoods (90.3%; 95% CI, 89.0%–91.5%). Survival differences persisted at 10 years. The unadjusted hazard of death for redlined exposed individuals with cancer was higher than redlined unexposed (hazard ratio [HR], 1.62; 95% CI, 1.39–1.89). In the fully adjusted model, mortality remained higher for redlined cases (HR, 1.32; 95% CI, 1.12–1.56). There did not appear to be effect modification from area-level poverty in the relationship between redlining and death (p = .49).

Conclusions

Among young individuals with cancer, residence at diagnosis in previously redlined neighborhoods was associated with lower survival compared with those residing in nonredlined neighborhoods, supporting the hypothesis that structural racism exerts persistent effects on contemporary health outcomes.