Is housing assistance associated with earlier stage cancer diagnosis?

• In Event: Exploring the lifecycle of housing assistance’s economic and health impacts, from application to long-term follow-up

Abstract

Late-stage cancer diagnosis is associated with high morbidity and mortality and is a contributing factor to cancer disparities. A growing number of older adults live in unaffordable and unstable housing. Whether programs designed to counter housing insecurity contribute to earlier stage cancer diagnosis remains largely unknown.  We sought to examine the association between the receipt of federal housing assistance and cancer stage at diagnosis.  The project used newly linked data that contains detailed information on cancer from the Surveillance, Epidemiology, and End Results (SEER) program which covers approximately 48% of the US population, Medicaid claims data, and data from U.S. Department of Housing and Urban Development. Individuals aged 66-95 years who were newly diagnosed with female breast, colorectal, non-small cell lung (NSCL), or prostate cancer between 2007 and 2019 were included in the study. After identifying individuals who were receiving housing assistance at the time of their diagnosis, we identified controls without housing assistance at diagnosis, who were propensity score matched in a 3:1 ratio separately by cancer site on a wide range of sociodemographic and clinical characteristics. Associations of housing assistance and diagnosis stage (regional, distant vs. localized) were examined with separate multinomial regression models by cancer type. The study included a total of 16,064 individuals with breast, 10,807 with colorectal, 17,156 with NCSL, and 8,505 with prostate cancer had housing assistance at diagnosis.  Compared to matched controls, fewer individuals with housing assistance were diagnosed with distant breast (6.7 vs. 7.2%; adjusted Odds Ratio [OR] 0.85, 95% Confidence Interval [CI] 0.82, 0.90), colorectal (22.2 vs. 23.3%, OR 0.90, 95% CI 0.83, 0.98), and NSCL (51.4 vs. 54.2%, OR 0.83, 95% CI 0.79, 0.86) compared to localized cancers. Housing assistance was not significantly associated with stage for individuals with prostate cancers. The association between housing assistance and stage at cancer diagnosis varied across the different types of housing assistance, including Housing Choice Vouchers, multifamily housing, and public housing. Federal housing assistance is associated with earlier-stage breast, colorectal, and NSCL cancer diagnoses, highlighting its potential role in mitigating the adverse effects of housing insecurity on cancer outcomes. 

Author

• Craig Pollack, Johns Hopkins University
  Presenting Author