Contemporary Area-Level Mortgage Loan Denial Risk and Health-Related Quality of Life Among Cancer Survivors

Historical and contemporary mortgage lending practices have been associated with worse cancer outcomes. We estimated the association between mortgage loan denial risk and health-related quality of life (HRQoL) among survivors at a large tertiary medical center in North Carolina (NC).

Mortgage denial risk, calculated using Home Mortgage Disclosure Act data (2010-2014), was linked by census tract to UNC Cancer Survivorship Cohort survivors who resided within NC metropolitan statistical areas (MSAs). HRQoL was measured using the validated Functional Assessment of Cancer Therapy-General (FACT-G). Differences in well-being across seven MSAs were assessed using Pearson chi-square tests and modified Poisson regression models adjusted for demographic and socioeconomic characteristics.

Over 40% of survivors reported low overall well-being, while more than one-third of survivors reported low physical, social, emotional, or functional well-being. FACT-G scores were 6.2 (95% CI: 1.5, 10.9) points lower among Greensboro survivors; 4.1 (95% CI: 0.1, 8.1) points lower among Fayetteville MSA survivors; and 9.6 (95% CI: 2.5, 16.8) points lower among Charlotte survivors at a higher risk for mortgage loan denial compared to those at lower risk. Racial differences in FACT-G scores were only observed among Greensboro and Charlotte MSA survivors, whereas sex differences were limited to Charlotte survivors.

Mortgage loan denial was associated with worse overall HRQoL in Greensboro, Fayetteville, and Charlotte, but not in other NC MSAs. Further investigation into the role of place in other NC MSAs is needed to identify opportunities to support survivors across the cancer control continuum.