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

项目摘要 老年人癌症护理和结果的社会经济和种族差异一直存在 近年来甚至有所扩大。与此同时，缺乏安全和负担得起的住房已成为一个 国家危机。尽管住房不安全有很大的潜力影响癌症的不平等， 将这两个区域联系起来的证据住房援助、成果、医疗保健和SEER （HOMES）研究是对住房不安全与癌症之间关系的高度创新性调查 不平等它侧重于联邦住房援助的作用，通过各种方案，包括 住房选择权、公共住房和多户住房限制了家庭在租金和 公用事业。通过提高住房负担能力和稳定性，改善住房质量，改变邻里关系， 背景下，并连接居民与健康和社会服务，联邦住房援助有潜力 提高癌症患者接受的护理质量，更广泛地说， 癌症和住房。这项研究的重点是老年人诊断乳腺癌，结直肠癌，前列腺，和非- 鉴于小细胞肺癌的高发病率和有据可查的不平等现象，这项研究利用了一个 美国国家癌症研究所正在构建一个新的数据集，该数据集合并了SEER-Medicare数据， 患者诊断（2006-2019）与美国住房和城市发展部的数据收据 联邦住房援助。因为接受住房援助的个人可能从根本上 与那些不这样做的人不同，这项研究使用了一种创新的伪等待列表控制设计， 利用住房援助相对于需求的有限供应和接收住房援助的随机时间， 住房援助。第一个目标是审查获得联邦住房与 援助和癌症护理（治疗时间、接受指南一致护理、急诊科 访视）和结果（诊断时的阶段）。第二个目的是调查这些关系是否因 鉴于与癌症不平等和住房政策相互交织的系统性种族主义的经历， 种族/民族。最后的目的是研究住房援助和癌症护理之间的联系是否 结果因住房援助的形式和不同的邻里环境而异。知情 由一个政策咨询委员会与美国癌症协会的代表联合举办。 行动网络和国家癌症圆桌会议，家庭研究具有强大的潜力，提供 可操作的住房和癌症政策建议，并告知旨在改善 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.