Is federal housing assistance associated with earlier-stage cancer diagnosis? Evidence from the new SEER-Medicare and US Department of Housing and Urban Development data linkage.

85 Background: Despite growing awareness that stable and affordable housing is a key social determinant of health, little research has examined the role of federal housing assistance in cancer outcomes. This study uses a novel data linkage to examine the association of federal housing assistance (i.e. various rent subsidy programs) on stage at diagnosis for the 4 most common cancers in the US. Methods: Individuals aged 66-95 years newly diagnosed with breast, colorectal, non-small cell lung (NSCLC) or prostate cancer in 2006-2019 with fee-for-service coverage were selected from SEER-Medicare Housing and Urban Development (HUD) administrative data. After identifying individuals with housing assistance at diagnosis, controls without housing assistance at diagnosis were propensity score matched in a 3:1 ratio by cancer site, age, sex, race/ethnicity, marital status, registry, year of diagnosis, area-level Yost socioeconomic status index, dual Medicaid eligibility, rural/urban residence, reason for Medicare entitlement, and pre-diagnosis comorbidity. Associations of housing assistance and diagnosis stage (SEER summary stage: localized vs. regional/distant) were examined with separate logistic regression models by cancer type. Results: A total of 7335 individuals with breast, 5660 with colorectal, 7399 with NSCL and 4309 with prostate cancer received housing assistance at diagnosis (Table). Compared to matched controls, a smaller percentage of individuals with housing assistance were diagnosed with regional/distant breast (36% vs. 33%), colorectal (59% vs. 57%), and NSCL (71% vs. 69%) cancers. Individuals receiving housing assistance were less likely to be diagnosed with later-stage breast (OR: 0.87; 95% CI: 0.83, 0.92) and NSCL (OR: 0.93; 95% CI: 0.88, 0.99) cancers. Housing assistance was not significantly associated with stage for individuals with colorectal or prostate cancers. Conclusions: Federal housing assistance is associated with earlier-stage breast and NSCL cancer diagnosis, highlighting its potential role in mitigating the adverse effects of housing insecurity on cancer outcomes. Housing assistance and cancer diagnosis stage. No Housing Assistance at Dx,N (%) Housing Assistance at Dx,N (%) OR [95% CI], P Breast Localized 14291 (64) 4890 (67) 1.0 (ref) Regional/Distant 8179 (36) 2445 (33) 0.87 [0.83, 0.92] P<0.001 Colorectal Localized 7046 (42) 2422 (43) 1.0 (ref) Regional/Distant 9934 (59) 3238 (57) 0.95 [0.89, 1.01] P=0.09 NSCLC Localized 6572 (30) 2298 (31) 1.0 (ref) Regional/Distant 15625 (71) 5101 (69) 0.93 [0.88, 0.99] P=0.02 Prostate Localized 10293 (80) 3401 (79) 1.0 (ref) Regional/Distant 2634 (20) 908 (21) 1.04 [0.96, 1.14] P=0.33 Dx=Diagnosis; OR=Odds Ratio; CI=Confidence Interval.