Housing assistance, Outcomes, Medicare, and SEER (HOMES)

Investigating the link between housing security and cancer outcomes.

Background: Socioeconomic and racial disparities in cancer care and outcomes among older adults have been persistent and even widened in recent years. At the same time, the lack of safe and affordable housing has become a national crisis. This study seeks to understand the ways that cancer outcomes and housing security are related to one another, focusing in particular on the role of federal housing assistance.

Approach: The Housing assistance, Outcomes, Medicare, and SEER (HOMES) study makes use of a novel dataset constructed by the National Cancer Institute that merges linked SEER-Medicare data on patients diagnosed (2006-2019) with U.S. Department of Housing and Urban Development data on the receipt of federal housing assistance. The study examines whether housing assistance is associated with differences in stage at diagnosis, survival, and receipt of guideline concordant care. It focuses on breast, prostate, colorectal, and lung cancers given their high burden of disease and known inequities in outcomes. The study further investigates whether these associations differ across types of housing assistance (Housing Choice Vouchers, public housing, and multifamily housing), by neighborhood socioeconomic status, and individual’s sociodemographic characteristics.

Findings: A systematic review of the 31 studies examining the association between housing and cancer was published in the Journal of the National Cancer Institute. A paper describing the creation of the linked cancer registry-Medicare claims-and HUD data set was also published in the Journal of the National Cancer Institute.  More information on the linked dataset can be found here. 

Approach: Our team is exploring these relationships with current projects that include a systematic review of the research linking housing and cancer and investigating the impact of historic redlining and contemporary mortgage discrimination on lung cancer mortality. The team has also been involved in the creation of the SEER-Medicare and U.S. Department of Housing and Urban Development (HUD) linked dataset which will, for the first time, enable researchers to study the impact of housing assistance using cancer registry together with claims data.  

Team: The study team is led by Craig Pollack and Robin Yabroff at the American Cancer Society. It includes Amanda Blackford, Taylor Craig, Syed Qasim Hussaini, Qinjin Fan, Katherine Chen, Joan Warren, Margaret Katana Ogongo, Daniel Polsky, Cary Gross, Josephine Feliciano, Daniel Song, Susan Gearhart, and Oluseyi Aliu.