Neighborhood-level financial exclusion and cancer screening disparities in the US: 2018–2022.

99 Background: Socioeconomic inequities limit access to cancer screening, undermining the benefits of early detection. While neighborhood-level financial exclusion, such as home loan denial rates (HLDRs) for conventional mortgages, may reflect broader access barriers, its relationship to screening uptake is poorly understood. We examined how HLDRs impact cancer screening utilization across American neighborhoods. Methods: We obtained cancer screening data from CDC PLACES, which utilizes BRFSS data and small-area estimation to generate census tract-level data. Outcomes included mammography among women 50–74y (2018, 2020, 2022), cervical cancer screening among women 21–65y (2018, 2020), and colorectal cancer screening among adults 45–75y (2018, 2020, 2022). Utilizing the Home Mortgage Disclosure Act database, we calculated HLDRs by census tract, matched to the same time period described for each screening outcome (2017-2018, 2019-2020, 2021-2022). HLDRs and census tract median income for corresponding years (from ACS 5-year estimates) were categorized into quintiles. We used univariable and multivariable beta generalized linear mixed models to examine the association between HLDRs and screening, adjusting for tract-level age, race, income, rurality, insurance status, and routine care access. Reported statistics include adjusted odds ratios (aOR) and 95% confidence intervals (CI). Results: Cohort included >82, 000 census tracts across the US. Individuals residing in census tracts with higher mortgage denials rate were more likely to be younger (<40y), have higher proportions of Black/AA residents, lower household income (<40k), no health insurance, and living in an urban center. In fully adjusted models (Table), odds of colorectal screening was 8. 5% lower in the highest HLDR quintile (≥21. 9%) compared to the lowest HLDR (<10. 6%). Similar patterns were seen for breast (4. 8% lower odds) and cervical cancer screening (3. 8% lower odds). Notably, this relationship between HLDR and cancer screening persisted across all income levels: within each income stratum (≤40k, 40-49k, 50-62k ≥63k), neighborhoods with higher HLDR were consistently associated with lower odds of each cancer screening (p < 0. 001 for all). Conclusions: Neighborhood-level financial exclusion, reflected in mortgage denials, is a novel and consistent predictor of lower cancer screening at all income levels. Federal policy efforts should integrate financial access measures to guide screening outreach and tackle structural cancer disparities. Multivariable analysis (aOR and 95% CI) of cancer screening and HLDR. HLDR Colorectal Breast Cervical ≥21. 9% 0. 92 (0. 91, 0. 92) 0. 95 (0. 95, 0. 96) 0. 95 (0. 95, 0. 96) 16. 7% - 21. 8% 0. 95 (0. 94, 0. 95) 0. 97 (0. 97, 0. 97) 0. 97 (0. 96, 0. 97) 13. 5% - 16. 6% 0. 96 (0. 96, 0. 96) 0. 97 (0. 97, 0. 98) 0. 98 (0. 98, 0. 98) 10. 6% - 13. 4% 0. 98 (0. 97, 0. 98) 0. 98 (0. 98, 0. 99) 0. 99 (0. 99, 0. 99) <10. 6% Ref Ref Ref