Complex interplay between housing insecurity and forgone care among U.S. cancer survivors.

Abstract

11010 Background: One-sixth of U.S. cancer survivors experience housing insecurity, and one-fifth report delaying or forgoing care due to costs. The role of social determinants of health (SDoH) among cancer survivors is complex and poorly understood. We sought to examine the prevalence of housing insecurity and forgone care, and their effects in conjunction with SDoH among cancer survivors. Methods: The Medication Expenditure Panel Survey (MEPS) is an annual survey representative of the civilian, non-institutionalized United States population. The 2022 MEPS survey included a Preventative Care Self-Administered Questionnaire measuring late rent/mortgage payments indicative of housing insecurity in the past year. We considered adult cancer survivors (excluding non-melanoma skin cancer) who reported an inability to afford or had to delay any medical/dental care or prescription medications, as forgoing care. We extracted sociodemographic and clinical characteristics. Survey-adjusted Wilcoxon rank-sum tests and chi-square tests assessed differences in continuous and categorical variables, respectively, for individuals with and without housing insecurity, cancer, and forgone care. A multivariate regression analysis adjusting for age, sex, race, and poverty status identified predictors of forgoing medical care. We conducted weighted analyses to account for the complex survey design and considered p < 0.05 as statistically significant. Results: A total of 1,776 cancer survivors (weighted (w): 21,088,176) and 20,655 individuals with no cancer (w: 311,965,067) were identified. Among cancer survivors, 13% (w: 1,315,879) reported housing insecurity while 19% (w: 4,063,946) were forgoing care. Housing insecurity was reported in 8% of female survivors compared to 4% of male survivors, while 22% of women forwent care compared to 16% of men. Black Americans were less likely to report forgone care (13%) compared to White (19%) and Hispanic cancer survivors (25%), while housing insecurity was higher among all minorities (~10%) compared to White survivors (5%). Younger cancer survivors aged 18-45 years reported four-fold rates of housing insecurity and 1.5 times the rate of forgone care compared to survivors over 65. Multivariate logistic regression revealed forgoing medical care was more prevalent in individuals aged 45–64 (aOR = 1.6), women (aOR = 1.5), the near poor (aOR = 2.9), and those experiencing housing insecurity (aOR = 4.1), but less prevalent in Black Americans (aOR = 0.5) (all p < 0.05). Conclusions: This is the first nationally representative study to report the complex interplay between housing insecurity and forgone care among cancer survivors. The interactions highlight some unexpected high-risk groups like women, near-poor individuals, and middle-aged individuals, who are more likely to forgo care when forced to choose or prioritize care. Future policies need to target these high-risk groups.