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Research has shown that breast cancer outcomes are affected by racial and socioeconomic disparities, and a new study delved deeper into this issue by linking breast cancer outcomes with mortgage discrimination based on property location.

Kristen Beyer, PhD, of Medical College of Wisconsin in Milwaukee, and colleagues examined outcomes in 27,516 women ages 66-90 with an initial breast cancer diagnosis in 2007-2009, followed through 2015. Data were obtained from the Surveillance, Epidemiology and End Results (SEER) Medicare database

As explained in the study online in the , the team created a mortgage redlining index using information from the Home Mortgage Disclosure Act. Linking this index with the SEER data, the researchers found an association between breast cancer-specific mortality and discriminatory lending practices. The association was linear, and strongest in women without comorbidities. Women in areas where it was the most difficult to get a home loan had a 28% higher risk (HR 1.28, 95% CI 1.06-1.55) compared with women in areas where it was the easiest.

"The magnitude of this neighborhood-level effect demands an increased focus on upstream social determinants of health to support comprehensive patient care," Beyer and colleagues wrote. "The housing sector actively reveals that structural racism and economic disinvestment and is an actionable policy target to mitigate negative upstream determinants of health for the benefit of patients with cancer."

In the following interview, Beyer, associate professor in the Division of Epidemiology and director of the PhD Program in Public & Community Health, elaborated on the details of the study.

Why did you choose to explore the relationship between health outcomes and discriminatory lending, rather than other racial or socioeconomic factors?

Beyer: Racial segregation is an upstream contributor -- and perpetrator -- of adverse socioeconomic and related exposures. Our measure of bias in mortgage lending is similarly located upstream, and is a policy-relevant target for efforts to reduce adverse neighborhood effects on cancer patients.

Your study found that the association was strongest in women without comorbidities. What is the significance of that?

Beyer: Women without comorbidities at diagnosis of cancer might be expected to have more favorable prognoses. Our study indicates that mortgage lending bias is still an adverse impact on survival among these women who might otherwise have a very strong prognosis.

What are some of the potential explanations between mortgage redlining and breast cancer survival?

Beyer: Explanations of the association might include differences in access to quality healthcare, environmental stressors, or lack of health-promoting neighborhood features (i.e., healthy foods, bike lanes, etc.) due to economic disinvestment.

How does this study relate to the other research you have been conducting in this area?

Beyer: My research focuses on health disparities and neighborhood-level factors driving these disparities. Mortgage lending bias might be considered as a critical upstream, policy-targetable driver of disparities in numerous health conditions, and it is highly related to disparities in positive features of neighborhoods that are not equally or equitably distributed across populations, consisting of environmental injustice.

Is there anything else you want to make sure healthcare providers understand about your study?

Beyer: As noted in the accompanying our article, healthcare providers have a responsibility to make themselves aware of the many influences on their patients' health and wellness, and to be part of the dismantling of structural racism in order to realize optimal patient care and outcomes for all people.

Read the study here and expert commentary about the clinical implications here.