Federal housing assistance, cancer care, and overall survival among older adults with prostate cancer.

Abstract

Survival disparities in prostate cancer are driven in part by social and economic factors, including housing insecurity. Rent subsidies in the form of federal housing assistance are a well-established strategy for alleviating housing insecurity, but their association with prostate cancer care and survival is unknown. Using linked federal housing assistance data, SEER cancer registry data, and Medicare claims, we assessed workup and treatment receipt and two-year survival among individuals aged 66 to 95 who were diagnosed with prostate cancer in 2007 to 2019. We used logistic and Cox regression models to compare outcomes between individuals receiving housing assistance upon prostate cancer diagnosis and a comparison group without housing assistance, using propensity score matching to balance sociodemographic and clinical characteristics. There were 1,839 individuals with housing assistance (and 5,517 without assistance) included in the workup and treatment analyses and 4,451 individuals with housing assistance (and 13,353 without assistance) in the survival models. Receipt of housing assistance was not associated with guideline-concordant workup (62.7% vs 61.2%, OR 1.02 [95% CI 0.97, 1.07], p = 0.48) or active treatment (63.7% vs 62.2%, OR 1.02 [95% CI: 0.99, 1.06], p = 0.22) but was associated with improved overall survival in the 2 years following diagnosis (hazard ratio for mortality: 0.88 [95% CI: 0.81, 0.96]). Older adults receiving housing assistance at the time of a prostate cancer diagnosis experienced better overall survival than a matched comparison group without housing assistance. Results suggest that expanding access to housing assistance might support greater and more equitable survival in prostate cancer.