Draw a DAG that represents the authors’ hypothesis on historical redlining and lung cancer screening.

Draw a DAG that represents the authors’ hypothesis on historical redlining and lung cancer screening. Include only the exposure. outcome. and race and gender in your DAG. @jectivc The objective of this study was to understand the effect of historical rcdlining (preclusion from home loans and wealth- building for Black Americans) and its downstream factors on the completion of lung cancer screening in Boston. Methods Patients within our institution were identified as eligible for lung cancer screening on the basis ofthe United State Preventive Service Task Force criteria and patient charts were reviewed to detertnine ifpatients completed low-dose computed tomography screening. Individual addresses were geocoded and overlayed with original [930 Home Owner Loan Corporation redlining vector files. Structural equation models were used to estimate the odds of screening for Black and White patients. interacted with sex. in redlined and nonredlincd areas. Results Black patients had a 44% lower odds ofscrccning compared with White (odds ratio [OR]. 0.66; 95% Cl. 0.52-0.85]. With race as a mediator. Black patients in redlined areas were 61% less likely,r to undergo screening than White patients (OR. 0.39; 95% CI. 0.24-0.64]. Similarly, in redlined areas Black women had 61% (OR. 0.39; 9 ’34; CI. 0.21-0.73) and Black men 47% (OR, 0.53; 95% CI. 0.29-0.98) lower odds of screening compared with White men in redlined areas. Conclusions Despite higher rates oflung cancer screening in redlined areas. Black race mediated worse screening rates in these areas. suggesting racist structural factors contributing to the disparities in lung cancer screening completion among Black and White patients. Furthermore. these disparities were more apparent in Black women. suggesting that racial and gender intersectional discrimination are important in lung cancer screening completion.