Risk of federal housing assistance loss following a cancer diagnosis in older adults.

240 Background: Housing insecurity is a growing problem in the US and is linked with worse cancer outcomes and increased mortality compared to individuals with secure housing. The availability of federal housing assistance to mitigate housing insecurity—through housing vouchers, public housing, and related programs—may support better cancer care and outcomes. Households receiving housing assistance must complete a recertification process roughly every 1 to 3 years to maintain this support. For individuals with cancer and their household caregivers, the physical and mental demands of cancer and its treatment may make it especially difficult to manage the administrative burden of recertification, increasing their risk of losing housing assistance. This study examined whether a cancer diagnosis is associated with a loss of federal housing assistance. Methods: Using the Surveillance, Epidemiology, and End Results (SEER) Cancer Registry-Medicare data linked with administrative records from the US Department of Housing and Urban Development (HUD), we identified 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 with at least one episode of housing assistance between 2006 and 2020. Using a modified case-crossover design, which leverages cancer patients as their own controls, we modeled the time from first housing episode to loss of housing assistance (event) or death/study end (censor) with cancer diagnosis as a time-dependent exposure. The risk of losing housing assistance in the time after a diagnosis relative to before was estimated with a Cox proportional hazards model. Results: The study included 81,677 individuals (24,946 breast, 16,532 colorectal, 25,164 NCSL, and 14,635 prostate cancer). At diagnosis, 53,327 (66%) were receiving housing assistance, 16,979 (21%) lost their housing assistance before diagnosis, and 10,971 (13%) obtained housing assistance after diagnosis. The median time from initiating housing assistance to loss of housing assistance was 11.6 years. The rates of loss of housing assistance in the periods before and after cancer diagnosis were 5.2 and 6.9 per 100 person-years, respectively. Cancer diagnosis was associated with a significantly increased risk of housing assistance loss (Hazard Ratio (HR) 1.32; 95% CI [1.28–1.36]; p < 0.001). Conclusions: A cancer diagnosis is associated with increased risk of loss of housing assistance in older adults. Policies that streamline housing recertification or provide temporary protection post-diagnosis may be considered to support continued housing stability during a vulnerable period.