People in neighborhoods deemed undesirable by the U.S. government almost 90 years ago still receive poorer care for colon cancer than those in other places, according to a new study of nearly 150,000 patients.

The study, by lead author Dr. Qasim Hussaini, an oncologist and researcher at UAB, looked at a range of outcomes in almost 200 cities where the government rated neighborhoods for mortgage lending in ways that discriminated against minorities. The practice that came to be known as redlining categorized areas by color – green, blue, yellow and red – and limited the ability of people in lower-rated areas to get mortgage loans and build wealth.

Hussaini and his team found far-reaching associations between the ranking of a neighborhood and treatment of colon cancer. Patients in red areas tended to receive later diagnoses and lower quality of care compared to those in green areas. Even the patients who received early diagnoses in red neighborhoods did not do as well as people in other areas, which is a frustrating finding for Hussaini, who treats patients with colon cancer.

“If you can catch this cancer early, you can treat it early,” Hussaini said. “If you can treat it early, you can potentially cure the patients early. So, it lends itself very well to looking at how the social and neighborhood aspects of where people live impact access to care.”

The research revealed that doctors were less likely to treat patients from red neighborhoods with the recommended care. One example was the number of lymph nodes removed and tested for cancer spread.

“Even when patients are on the operating table with the surgeons, patients who are coming from redlined neighborhoods are having less lymph nodes evaluated,” Hussaini said. “We want to evaluate all the lymph nodes.”

It’s unclear why patients from red neighborhoods don’t receive the same level of care.

Patients may face barriers to receiving care after diagnosis. If they lack insurance or can’t pay for procedures, patients may delay surgery or chemotherapy.

“It’s one thing to get people screened,” Hussaini said. “And a lot of people think the buck stops there, getting someone a diagnosis. But that’s really just the beginning of the journey and then there’s a whole long continuum of care they have to tap into.”

Another hypothesis is that doctors at hospitals that serve a lot of patients may not have time to remove and analyze as many lymph nodes as those in other areas.

“What we found that was very surprising was even the patients getting diagnosed at early stages in the redlined neighborhoods still had shorter survival,” Hussaini said. “There’s something happening between people getting diagnosed at an early stage with a curable cancer and whatever happens after that point in those people lives.”

The study examined patient care and outcomes from 2007 to 2017 in 196 cities where historic housing discrimination happened in the 1930s. It was published February issue of the Journal of Oncology Practice.

Hussaini has studied links between historic housing discrimination and cancer care. He hopes this research could be a model for other researchers who want to look at other health outcomes in multiple cities with redlining. At least two Alabama cities, Birmingham and Montgomery, were included in the analysis.

He hopes doctors and policy makers can take this information and make changes. At the hospital level, it could help ensure all patients receive appropriate care. Federal agencies can also improve care by increasing payments doctors receive for discussing issues related to housing or other difficulties, Hussaini said.

The study also shows how the long shadow of housing discrimination still affects people today. Although the government no longer categorizes neighborhoods in that way, mortgage discrimination still exists as banks still lend less money to minority customers, Hussaini said.

Where people live can have large effects on the type of education they get and the job opportunities they receive, Hussaini said. All that can affect health.

“Where people live in this country has a massive impact on what access they have to education, employment, and, under employment, their access to health insurance,” Hussaini said. “Where one lives in this country really is this master mediator of just how well people end up doing down the road.”