Increased risk of housing loss following cancer diagnosis.

224 Background: Cancer can lead to major socioeconomic challenges –i.e., work disruptions and income loss– that make it hard to afford essential basic needs such as housing. Alongside high cancer care costs, rising housing costs may pose financial hardships that increase risk of delinquent payments and housing loss. Our objective was to compare the risk of housing loss between cancer survivors and individuals with no history of cancer, using two measures: (1) potential housing loss: measured as presence of properties or loans in default or delinquent and (2) realized housing loss: measured any presence of foreclosures. Methods: Data from age-, sex-, and zip code–matched adult (age > 18 years) cancer survivors (Western WA cancer registry) and non-cancer controls (WA voter records) between 2013 to 2018 were linked to quarterly TransUnion credit records. Housing loss outcomes (binary, yes/no) were assessed over two 24-month time periods after the diagnosis/index date: 13-36 months (years 2-3) and 37-60 months (years 4-5). Individuals without continuous data throughout each time period and those with prior housing loss outcomes were excluded. Multivariable logistic regression models were used to evaluate the association of cancer diagnosis with housing loss outcomes, adjusting for individual- and neighborhood-level sociodemographic factors. Results: A total of 302,355 individuals for the 3-year cohort (199433 controls, 102822 survivors) and 181,326 individuals for the 5-year cohort (124133 controls, 57193 survivors) were included. In years 2-3 adjusted models, cancer survivors had significantly greater risk of delinquent/default accounts (odds ratio [OR]:1.38, 95% confidence interval [95% CI]:1.26-1.51) and foreclosure (OR:1.39, 95% CI:1.05-1.84). In years 4-5 adjusted models, cancer survivors had significantly greater risk of delinquent/default accounts (OR:1.31, 95% CI:1.15-1.49), though foreclosure risk was not significant (OR:1.17, 95% CI:0.80-1.70). Conclusions: Our findings underscore the elevated risk of housing loss within 5 years following a cancer diagnosis. Cancer survivors experienced greater risk of default or delinquent property/loan accounts than non-cancer individuals, which may serve as an indicator of potential future housing loss and may help identify a high-risk population for housing loss-prevention programs. Strategies to prevent foreclosure among cancer survivors may be most impactful within 3 years following diagnosis, when the risk of realized housing loss is greatest. Routine, standardized assessment of housing insecurity and other social needs following a cancer diagnosis is critical within the oncology setting; such efforts will enable delineation of the pathways through which cancer survivors experience housing loss and inform approaches to improve both social and health outcomes. Future research on housing insecurity among cancer survivors should include data on rent payments and eviction.