Persistent mortgage discrimination linked to breast cancer disparities, study shows

Published on Monday, March 25, 2024

By: Andrea Wright Dilworth, awdilworth@umc.edu

Photos By: Joe Ellis/ UMMC Communications

Black women who live in historically redlined communities are more likely to be diagnosed with estrogen receptor-negative breast cancer, an aggressive subtype of the cancer, while white women are at an increased risk of late-stage diagnosis. Black women are also more likely to die of the disease, regardless of where they lived.

Those were three key findings of the study, “Historical redlining, persistent mortgage discrimination, and race in breast cancer outcomes,” published in February in JAMA Network Open.

Dr. Jasmine Miller-Kleinhenz, assistant professor of population health science in the John D. Bower School of Population Health, had always wondered why Black women are more likely to develop aggressive forms of breast cancer. Since no other study had looked at the effects of persistent mortgage discrimination – areas that are historically and contemporarily redlined – on breast cancer outcomes, she conducted her own.

Roughly 240,000 cases of breast cancer are diagnosed in women and 2,100 in men each year, according to the Centers for Disease Control and Prevention. Annually, about 42,000 women and 500 men die year from the disease, with Black women dying at the highest rate.

Redlining is a discriminatory mortgage practice that used race as a central factor in determining credit worthiness. Though outlawed in the 1960s, mortgage discrimination is still an ongoing practice, Miller-Kleinhenz said.

“The primary takeaways are that living in a historically redlined area is associated with poor outcomes that differ by race,” she said. “Black women had an increased risk, more than three times that of White women, no matter where they lived.”

The SOPH assistant professor was surprised by the results because they show that while neighborhood conditions may be a key cause of mortality in white women, there are additional factors contributing to poor outcomes in Black women.

In recent years, evidence has shown that people living in historically redlined neighborhoods have an increased risk of diabetes, hypertension, early mortality from heart disease, and mental health issues. Research has also studied the effect of redlining on breast cancer mortality, but few that connected it with different subtypes of breast cancer.

To conduct the study, Miller-Kleinhenz, then a postdoctoral fellow at the Rollins School of Public Health at Emory University, used Georgia Cancer Registry data. She studied a sample that included 1,764 non-Hispanic Black and white women with a breast cancer diagnosis living in areas graded by the Home Owner’s Loan Corporation, the federal agency that once flagged neighborhoods with large Black communities as too risky for the mortgage loans.

“The strongest predictors of health are derived from the social environment in which people live,” said Dr. Thomas Dobbs, SOPH dean. “Dr. Miller-Kleinhenz's study outlines the tangible negative effects of historical and persistent structural racism. It serves as a springboard for future research and suggests societal approaches to intervening against these adverse forces.”

Miller-Kleinhenz joined SOPH in January after completing her fellowship. “We are excited to bring Dr. Miller-Kleinhenz and her compelling work to UMMC,” Dobbs said.

The breast cancer mortality gap between Black and white women has existed for roughly 40 years, Miller-Kleinhenz said.

“One of the factors that is thought to contribute to this gap is that Black women are more likely to be diagnosed with triple-negative breast cancer, which is an aggressive form with poorer survival than other breast cancer subtypes,” she said. “While this might be one of the factors, it is not the only factor. Research is ongoing that goes beyond individual factors -- heredity, lifestyle, obesity, reproductive factors, etc., and includes societal-level factors like persistent poverty, structural racism, or environmental exposures.”

Miller-Kleinhenz said she believes Black women encounter numerous stressors at many levels throughout their lives not only at the personal level, but because of the way society is structured. That impacts a number of factors, including education, work opportunities and health care access. Researchers need to collect data over time to better capture women’s exposure to those stressors, she said.

She hopes her study will bring about an increased awareness of the complexity of what drives those poor outcomes, since it is becoming increasingly clear that all women, Black and white, are negatively impacted by historical, contemporary and persistent discrimination.

 “Discrimination hurts everyone, and if we want a healthier society, we need to eradicate discriminatory practices and dismantle systems that perpetuate inequities.”