Impact of Redlining on Healthcare Disparities in Gastrointestinal Cancer
Author Information
Author(s): Chatzipanagiotou Odysseas P. MD, Woldesenbet Selamawit MS, MPH, PhD, Munir Muhammad Musaab MBBS, Catalano Giovanni MD, Khalil Mujtaba MBBS, Rashid Zayed MBBS, Altaf Abdullah MBBS, Pawlik Timothy M. MD, PhD, MPH, MTS, MBA
Primary Institution: The Ohio State University Wexner Medical Center
Hypothesis
The study aimed to assess the effect of redlining on oncological outcomes of patients with gastrointestinal cancer and identify mediators of the association.
Conclusion
Contemporary redlining contributed both directly and indirectly to disparities in oncological care and outcomes of patients with gastrointestinal cancer.
Supporting Evidence
- 32.2% of patients lived in high and highest redlining areas.
- Highest redlining was associated with 18.2% higher odds of advanced disease at diagnosis.
- Patients in the highest redlining areas had 26.7% lower odds of achieving textbook outcomes.
- Socioeconomic status mediated 45.6% of the association between redlining and nonreceipt of surgery.
- Racial/ethnic minority status contributed 19.7% to the effect of redlining on surgery receipt.
Takeaway
Living in areas affected by redlining can make it harder for people with gastrointestinal cancer to get the right treatment and have better health outcomes.
Methodology
Patients with colorectal or hepatobiliary cancer were identified from the SEER-Medicare database, and mediation analysis was used to identify socioeconomic, structural, and clinical mediating factors.
Potential Biases
Potential biases may arise from using historical data and the limitations of the redlining index.
Limitations
The study relied on census tract data, which may limit generalizability and introduce ecological fallacy.
Participant Demographics
Median age was 77 years, with 53.7% female; 65.9% of Black patients lived in high redlining areas.
Statistical Information
P-Value
p<0.05
Confidence Interval
95% CI 1.116–1.524
Statistical Significance
p<0.05
Digital Object Identifier (DOI)
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