A new study led by researchers from the Johns Hopkins Bloomberg School of Public Health found that older adults receiving federal housing assistance were on average diagnosed at earlier stages with three common cancers—colon, breast, and non-small cell lung—compared to peer cancer patients who were not receiving assistance.
The findings suggest that federal housing programs may provide supports that help improve cancer diagnosis. Early cancer diagnosis is key to better prognoses and has saved millions of lives.
For their analysis, the researchers linked information on federal housing assistance—housing choice vouchers, public housing, and multifamily housing—with data from cancer registries and Medicare. They compared the stage of cancer diagnosis among older patients receiving housing assistance at the time of their diagnosis to the stage of diagnosis among individuals with comparable demographics without housing assistance.
The nonidentifiable data included Medicare patients age 66 to 95 who were newly diagnosed with female breast, colorectal, non-small cell lung, or prostate cancer between 2007 and 2019. Taken together, these are the four most common nonskin cancers.
The researchers found that older adults with housing assistance had lower odds of being diagnosed with distant-stage disease for three cancers:
- Breast cancer: 6.7% with housing assistance were diagnosed at a distant stage versus 7.2% without housing assistance
- Colorectal cancer: 22.2% were diagnosed with distant stage cancer versus 23.3% without housing assistance
- Non-small cell lung cancer: 51.4% were diagnosed with distant stage disease versus 54.2% without housing assistance
The researchers found no significant association among prostate cancer patients.
The study was published online October 8 in JAMA Network Open.
"Stable, affordable housing contributes to health and also enables better access to the health care system," says Craig Pollack , MD, MSc, MHS, a professor in the Johns Hopkins Bloomberg School of Public Health's Department of Health Policy and Management and the paper's lead author. "By stabilizing housing costs and improving housing quality, assistance may remove barriers to preventive services and timely evaluation of symptoms. We see that reflected in earlier-stage diagnoses for several cancers."
Results varied by type of housing assistance for non-small cell lung and breast cancer. Housing Choice Vouchers enable families to rent homes in the private market; public housing is owned and operated by housing authorities; and multifamily housing provides rental subsidies tied to specific housing units.
For non-small cell lung cancer, earlier stage diagnosis was observed across Housing Choice Vouchers, public housing, and multifamily housing. For breast cancer, earlier-stage diagnosis was most evident among voucher holders and residents of multifamily housing. The authors note that multifamily programs often include on-site service coordinators, while vouchers may improve neighborhood access to care.
"These programs do more than cap rent at 30% of income," Pollack says. "Inspections can ensure quality living units, smoke-free policies can reduce exposure, and service coordinators can connect residents to screenings. The signal we're detecting likely reflects a combination of affordability, stability, and support."
The researchers drew from Medicare data maintained by the U.S. Department of Housing and Urban Development (HUD) for their analysis. The cohort receiving housing assistance at diagnosis comprised 52,532 patients—16,064 breast, 10,807 colorectal, 17,156 non-small cell lung, and 8,505 prostate cancer. Mean age was 76.3, and 72.7% were dually enrolled in Medicaid; 73.4% received Part D low-income cost sharing.
The authors note that housing assistance may, in addition to prolonging and possibly saving lives through earlier cancer diagnosis, translate to lower health care spending, as treatment costs are higher for individuals diagnosed with later-stage cancers. Overall, only about one in four households eligible for housing assistance receive it, according to the Center for Budget and Policy Priorities. HUD estimates that there are some 2.3 million older adults with very low incomes who do not receive housing assistance.
The researchers suggest that extending assistance to very low-income older renters who currently live in unaffordable housing could result in 378 fewer regional or distant breast, colorectal, and non-small lung cancer diagnoses annually, yielding roughly $15 million in first-year cancer care savings. The researchers note that these potential savings, while modest relative to national housing expenditures, align with broader health gains documented for rental assistance.
"If we care about detecting cancer early, we have to look upstream," says Pollack. "Strengthening and expanding housing assistance could be an important strategy to save lives."
The research was supported by the National Cancer Institute (R01CA269488).
" Federal Housing Assistance and Stage at Cancer Diagnosis Among Older Adults in the U.S. " was co-authored by Craig Evan Pollack, Amanda L. Blackford, Taylor K. Craig, Qinjin Fan, S.M. Qasim Hussaini, Katherine L. Chen, Daniel Polsky, Margaret Katana Ogongo, Joan L. Warren, Cary P. Gross, and K. Robin Yabroff.
