Cancer Stage at Diagnosis, Historical Redlining, and Current Neighborhood Characteristics: Breast, Cervical, Lung, and Colorectal Cancer, Massachusetts, 2001-2015.

In the 1930s, the federal Home Owners' Loan Corporation (HOLC) maps nationalized racial residential segregation via "redlining," whereby the color red designated areas with black, foreign-born, or low-income residents, which were deemed unsuitable for mortgage lending. We used the recently digitized HOLC redlining maps for 28 municipalities in Massachusetts to analyze Massachusetts Cancer Registry data for late stage at diagnosis for cervical, breast, lung, and colorectal cancer (2001-2015). Multivariable analyses indicated that, net of age, gender, and race/ethnicity, residing in a previously HOLC redlined area imposed an elevated risk for late stage at diagnosis even for residents of census tracts with present-day economic and racial privilege, whereas the best historical HOLC grade was not protective for residents of census tracts without such current privilege. For example, a substantially elevated risk of late stage at diagnosis occurred among men with lung cancer residing in currently privileged areas that had been redlined (relative risk (RR) = 1.17, 95% CI 1.06, 1.29), whereas such risk was attenuated among men residing in census tracts lacking such current privilege (RR = 1.01, 95% CI 0.94, 1.08). Research on historical redlining as a structural driver of health inequities is warranted.