{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T03:48:45Z","timestamp":1790135325059,"version":"4.0.1"},"reference-count":34,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>A growing number of older adults live in unaffordable and unstable housing; however, whether programs designed to counter housing insecurity contribute to earlier-stage cancer diagnosis remains largely unknown.<\/jats:p><\/jats:sec>Objective<\/jats:title>To examine the association between the receipt of federal housing assistance, which limits household spending on rent and utilities, and cancer stage at diagnosis among older adults in the US.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This comparative cohort study used the Surveillance, Epidemiology, and End Results cancer registry program and Medicare database linked with data from the US Department of Housing and Urban Development (HUD). Participants were individuals aged 66 to 95 years who received new diagnoses of breast cancer, colorectal cancer, non\u2013small cell lung cancer (NSCLC), or prostate cancer between 2007 and 2019. Data were acquired in 2023, and the data analysis was performed from June 2023 through March 2025.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Receipt of federal housing assistance.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcome was stage at cancer diagnosis, defined as in situ (for breast cancer only), localized, regional, or distant. Odds ratios (ORs) for the association between having HUD assistance at diagnosis and cancer stage at diagnosis were estimated using multinomial (nonproportional odds) regression. Individuals with HUD assistance were propensity score matched to individuals without housing assistance.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 52\u202f532 individuals (mean [SD] age at diagnosis, 76.3 [6.8] years; 33\u202f608 women [64.0%]) with housing assistance at diagnosis were included: 16\u202f064 had breast cancer, 10\u202f807 had colorectal cancer, 17\u202f156 had NCSLC, and 8505 had prostate cancer; 38\u202f183 (72.7%) were enrolled in Medicaid, and 38\u202f539 (73.4%) had Part D low-income cost sharing. Compared with matched controls, fewer individuals with housing assistance received a diagnosis of distant breast cancer (1071 patients [6.7%] vs 3485 patients [7.2%]; adjusted OR [aOR], 0.85; 95% CI, 0.82- 0.90), distant colorectal cancer (2398 patients [22.2%] vs 7562 patients [23.3%]; aOR, 0.90; 95% CI, 0.83-0.98), and distant NSCLC (8810 patients [51.4%] vs 27\u202f901 patients [54.2%]; aOR, 0.83; 95% CI, 0.79-0.86) compared with localized cancers. Housing assistance was not significantly associated with stage at diagnosis for individuals with prostate cancer. The association between housing assistance and stage at cancer diagnosis varied across the different types of housing assistance, including the Housing Choice voucher program, multifamily housing, and public housing.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>The findings of this cohort study of older adults with cancer suggest that federal housing assistance was associated with earlier-stage diagnosis of breast cancer, colorectal cancer, and NSCLC, highlighting its potential role in mitigating the adverse associations of housing insecurity with cancer outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.36281","type":"journal-article","created":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T15:00:51Z","timestamp":1759935651000},"page":"e2536281","source":"Crossref","is-referenced-by-count":3,"title":["Federal Housing Assistance and Stage at Cancer Diagnosis Among Older Adults in the US"],"prefix":"10.1001","volume":"8","author":[{"given":"Craig Evan","family":"Pollack","sequence":"first","affiliation":[{"name":"Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland"},{"name":"Johns Hopkins School of Nursing, Baltimore, Maryland"},{"name":"Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland"},{"name":"Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda L.","family":"Blackford","sequence":"additional","affiliation":[{"name":"Division of Quantitative Sciences, Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taylor K.","family":"Craig","sequence":"additional","affiliation":[{"name":"Biostatistics, Epidemiology and Data Management Core, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qinjin","family":"Fan","sequence":"additional","affiliation":[{"name":"Surveillance, Prevention, & Health Services Research (SPHeRe), American Cancer Society, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. 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Qasim","family":"Hussaini","sequence":"additional","affiliation":[{"name":"Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medicine, Baltimore, Maryland"},{"name":"O\u2019Neal Comprehensive Cancer Center, Division of Hematology & Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine L.","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Polsky","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland"},{"name":"Carey Business School, Johns Hopkins University, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"Katana Ogongo","sequence":"additional","affiliation":[{"name":"Surveillance, Prevention, & Health Services Research (SPHeRe), American Cancer Society, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joan L.","family":"Warren","sequence":"additional","affiliation":[{"name":"Surveillance, Prevention, & Health Services Research (SPHeRe), American Cancer Society, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cary P.","family":"Gross","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut"},{"name":"Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. 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