Housing assistance, Outcomes, Medicare, and SEER (HOMES): using a novel data linkage to understand cancer inequities

项目摘要 老年人在癌症护理和预后方面的社会经济和种族差异一直存在 最近几年甚至扩大了。与此同时，缺乏安全经济的住房已成为一种 国家危机。尽管住房不安全感很有可能影响癌症的不平等，但这一点很少。 将这两个地区联系起来的证据。住房援助、结果、医疗保险和SEER (HOME)研究是对住房不安全感和癌症之间关系的一项高度创新的调查 不平等。它侧重于联邦住房援助的作用，通过各种方案，包括 住房选择代金券、公共住房和多户住房限制了家庭在租金和 公用事业。通过增加住房可负担性和稳定性，提高住房质量，改变社区 在此背景下，将居民与健康和社会服务联系起来，联邦住房援助具有潜力 为了提高癌症患者接受的护理质量，更广泛地说，让人们明白这一点 癌症和住房的问题。这项研究的重点是被诊断患有乳腺癌、结直肠、前列腺癌和非乳腺癌的老年人。 鉴于小细胞肺癌的高发病率和有据可查的不平等现象。这项研究利用了一种 美国国家癌症研究所正在构建一种新的数据集，它将SEER-Medicare的关联数据合并到 收据上有美国住房和城市发展部数据的患者(2006-2019年) 联邦住房援助计划。因为接受住房援助的个人可能从根本上 与那些没有这样做的人不同，这项研究利用了一种创新的伪等待列表控制设计，该设计 利用住房援助相对于需求的有限供应和接受住房援助的随机时间 住房援助。第一个目标是检查收到联邦住房之间的总体关系 援助和癌症护理(治疗时间、接受指南一致性护理、急诊科 就诊)和结果(诊断阶段)。第二个目标是调查这些关系是否随 癌症网站，鉴于系统性种族主义的经历与癌症差距和住房政策相交织， 按种族/民族分类。最终目标是研究住房援助和癌症护理之间的联系 不同的住房援助形式和不同的社区环境，其结果也不同。知情者 由一个政策咨询委员会与美国癌症协会的代表联合 行动网络和国家癌症圆桌会议，HOME研究具有很强的潜力提供 可采取行动的住房和癌症政策建议，并为旨在改善的做法提供信息 癌症权益。

Project Summary Socioeconomic and racial disparities in cancer care and outcomes among older adults have been persisted and even widened in recent years. At the same time, the lack of safe and affordable housing has become a national crisis. Despite the strong potential for housing insecurity to impact cancer inequities, there is a paucity of evidence connecting these two areas. The Housing assistance, Outcomes, MEdicare, and SEER (HOMES) Study is a highly innovative investigation of the association between housing insecurity and cancer inequities. It focuses on the role of federal housing assistance which, through a variety of programs, including Housing Choice Vouchers, public housing, and multifamily housing, limit household spending on rent and utilities. By increasing housing affordability and stability, improving housing quality, changing neighborhood context, and connecting residents with health and social services, federal housing assistance has the potential to improve the quality of care that patients with cancer receive and, more broadly, shed light on the intersection of cancer and housing. The study focuses on older adults diagnosed with breast, colorectal, prostate, and non- small cell lung cancers given their high incidence and well-documented inequities. The study makes use of a novel dataset being 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. Because individuals who receive housing assistance may be fundamentally different from those who do not, the study makes use of an innovative pseudo-waitlist control design that leverages the limited supply of housing assistance relative to demand and the random timing of the receipt of housing assistance. The first aim examines the overall relationship between receipt of federal housing assistance and cancer care (time to treatment, receipt of guideline concordant care, emergency department visits) and outcomes (stage at diagnosis). The second aim investigates whether these relationships vary by cancer site and, given experiences of systemic racism that intersect with cancer disparities and housing policy, by race/ethnicity. The final aim studies whether the association between housing assistance and cancer care and outcomes varies by the form of housing assistance and across different neighborhood contexts. Informed by a policy advisory committee in conjunction with representatives from the American Cancer Society Cancer Action Network and National Cancer Roundtables, the HOMES Study has the strong potential to provide actionable housing and cancer policy recommendations and inform changes to practice designed to improve cancer equity.