Housing Linked to Lower Cancer Mortality Among U.S. Veterans

Housing is one of the primary social determinants of health, and researchers have found associations between housing and an improvement in a number of health conditions.

Research results reported in this month’s Health Affairs add another piece of evidence to the stack showing housing’s benefits by linking housing to a lower risk of mortality from lung annd colorectal cancer. Lead author Hannah C. Decker, M.D., of the University of California, San Francisco, and her colleagues said to their knowledge theirs is the first study to examine cancer mortality and survival outcome in a comparison of those who experience continuous housing to those experience homelessness after a cancer diagnosis.

Among approximately 100,000 veterans, they found that those who were housed when they received a diagnosis of lung cancer but subsequently lost their housing were 29% more likely to have died during the 2011-2020 study period than those who were consistently housed. Among those with colorectal, the difference was 18%.

Decker and her colleagues also found a mortality rate difference among those who were continuously unhoused and those who were continuously housed. The continuously unhoused with lung cancer were 9% more likely to have died from the disease than continuously housed and continuously unhoused veterans with colorectal cancer were 18% more likely to have died than their housed counterparts. The researchers also found that those went from being unhoused to housed had all-cause mortality similar to those who were continuously housed.

Identification of the reasons for mortality differences were beyond the scope of this study, but Decker and her authors mentioned some possibilities. Housing may be associated with an increased ability to alter health-related behaviors, such as smoking, and may help with the coordination and achievement of complex treatment regimens. They pointed to research that shows providers alter their clinical decisions for people who are unhoused and that gaining housing may come with additional supportive, including the attention of family and friend caregivers. They also acknowledge the possibility of reverse causation — worsening health associated with cancer may lead to circumstances that result in homelessness rather than the other way around.

Decker and her colleagues used the Veteran Affairs (VA) Corporate Data Warehouse to identify all the veterans who received care through the VA who had received a diagnosis of lung and colorectal cancer during the period from Oct. 1, 2011, through Sept. 30, 2020. Theyused medical records, a VA homeless registry and other sources to identify the housing status of veterans. Of the 108,675 veterans in the study, the vast majority (93.8%, or 101,987 individuals) were continuously housed and a small group (3.9%, or 4,197) were continuously unhoused.

There were 1,121 individuals who went from being unhoused at the time of their diagnosis to being housed sometime in the 12-month period afterward, and a slightly larger group of 1,370 individuals who went from being housed to unhoused in the 12 months after diagnosis.

The most common cancer was lung cancer, accounting for 69% of cases, followed by colorectal cancer (29% of diagnoses) and breast cancer (5% of diagnoses). Men made up 92% of the veterans in the study, which explains the low proportion of breast cancer diagnoses. The relatively small group of breast cancer patients may also explain why none of the differences in housing status and cancer mortality in that group reached statistical significance.

Decker and her colleagues credit the VA with working to address homelessness among veterans for the past three decades. “Our findings suggest that adopting the VA’s strategies in other settings where people without housing seek care, particularly for patients diagnosed with cancer, may help improve outcomes in this vulnerable population,“ they wrote.