Housing Insecurity and Threats of Utility Shut-Offs Among Cancer Survivors in the United States, BRFSS 2022-2023

Abstract

Background: The financial burden of cancer treatment can increase the risk of housing insecurity for patients undergoing treatment and survivors. Objective: To evaluate the burden of housing and utility insecurity among cancer survivors compared to individuals without a cancer history, examine outcome differences by housing tenure (renters vs. homeowners) and treatment status (active vs. posttreatment), and identify predictors of housing insecurity. Methods: We analyzed data from 14 states that completed the Social Determinants and Cancer Survivorship modules of the 2022 and 2023 Behavioral Risk Factor Surveillance System (BRFSS), yielding 5499 respondents with a previous cancer diagnosis (excluding skin cancers) and 61,883 respondents without a cancer diagnosis. We estimated prevalences and fit logistic regressions. Key results: Cancer history was associated with greater odds of housing (AOR 1.43, 95% CI: 1.18-1.74) and utility (AOR 1.36, 95% CI: 1.09-1.69) insecurity, but this varied by treatment timing and housing tenure. Patients currently undergoing treatment were more likely to report housing and utility insecurity (AOR 1.96, 95% CI: 1.28-3.01 and AOR 1.67, 95% CI: 1.06-2.61, respectively) than individuals without a history of cancer. Such insecurity was elevated even after treatment for renters, but not for homeowners. In absolute terms, 34.7% of renters with a cancer history reported housing insecurity, compared to 7.1% of their homeowner counterparts. Conclusions: Cancer diagnosis and treatment can contribute to housing and utility insecurity during and after treatment. Addressing this through targeted interventions within both healthcare systems and social policy may mitigate hardship and improve well-being.