Abstract C024: Historical redlining, race, poverty, and lung cancer incidence: A sub-borough level analysis in New York city

Abstract Background: Lung cancer is the third most diagnosed cancer and the leading cause of cancer-related deaths in the U.S. Disparities in incidence and mortality are stark and are influenced by a complex interplay of factors including socioeconomic status, access to care and smoking patterns. The impact of redlining - a discriminatory housing practice associated with exposure to environmental toxins and socioeconomic disadvantage - remains unclear. Thus, the purpose of this study was to investigate the association between historical redlining and lung cancer incidence in New York City sub-boroughs. Methods: We used an ecological study design incorporating Public Use Microdata Areas (PUMA) to investigate the association between historical redlining ascertained from the Mapping Inequality Project (2023) and age-adjusted lung cancer incidence rates from 2009-2013 period, from the NYC Government Environment and Health Data Portal. Redlining exposure was quantified by assigning numeric values to historical HOLC grades (A=1, B=2, C=3, D=4) and calculating a weighted average score for each PUMA with QGIS. The weight average was operationalized as “low grade” or “high grade” based on a score of less than 2.5 or 2.5 or greater, respectively. PUMA level poverty rates and racial/ethnic composition from Census 2010 data, as well as borough-level smoking rates and fine particles PM 2.5 data from NYC Environmental Health (2009-2013) were considered as potential confounders. We assessed the distribution of sociodemographic and health behaviors according to historical redlining grade. Associations between redlining grade and lung cancer incidence rates were assessed using age-adjusted and multivariable linear regression models. Results: Across 55 PUMAs, areas with high vs. low redlining had a higher average poverty rate (36.0% vs. 27.0%), and a higher average percentage of Black residents (26.2% vs. 17.4%). The average borough-level smoking rates (15.6% vs. 15.3%) and PM 2.5 fine particle levels (9.8 vs. 10.1) were similar between high vs. low redlining areas. The average age-adjusted lung cancer incidence was 43.12 per 100,000 in high areas, compared to 40.09 per 100,000 in low. In the age-adjusted model, high redlining area was associated with a non-significant 3.0-unit increase in lung cancer incidence (β = 3.02, 95% CI: –1.97, 8.02). In the adjusted model controlling for poverty, race, smoking, and pollution, the association remained non-significant (β = 3.57, 95% CI: –1.55, 8.70). However, higher smoking rates (β = 2.14, 95% CI: 0.20, 4.07; p = 0.03) and air pollution exposure (β = 4.29, 95% CI: 1.18, 7.40; p = 0.008) were associated with increased lung cancer risk. Conclusion: Our findings suggest that historical redlining is not associated with lung cancer incidence rates in NYC. Given that historically redlined areas have higher smoking rates and greater air pollution exposure - both linked to lung cancer – targeted efforts to address social and environmental health factors in these neighborhoods can help reduce persistent lung cancer disparities. Citation Format: Jordan E . O'Brien, Kelly Hirko, Amr Soliman. Historical redlining, race, poverty, and lung cancer incidence: A sub-borough level analysis in New York city [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr C024.