Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, GA, USA.
Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, MD, USA.
J Natl Cancer Inst. 2022 Dec 8;114(12):1601-1618. doi: 10.1093/jnci/djac173.
Access to stable and affordable housing is an important social determinant of health in the United States. However, research addressing housing and cancer care, diagnosis, and outcomes has not been synthesized.
We conducted a systematic review of studies examining associations of housing and cancer care and outcomes using PubMed, Embase, Scopus, and CINAHL. Included studies were conducted in the United States and published in English between 1980 and 2021. Study characteristics and key findings were abstracted and qualitatively synthesized.
A total of 31 studies were identified. Housing-related measures were reported at the individual level in 20 studies (65%) and area level in 11 studies (35%). Study populations and housing measures were heterogeneous. The most common housing measures were area-level housing discrimination (8 studies, 26%), individual-level housing status (8 studies, 26%), and individual-level housing concerns (7 studies, 23%). The most common cancer outcomes were screening (12 studies, 39%) and mortality (9 studies, 29%). Few studies assessed multiple dimensions of housing. Most studies found that exposure to housing insecurity was statistically significantly associated with worse cancer care (11 studies) or outcomes (10 studies).
Housing insecurity is adversely associated with cancer care and outcomes, underscoring the importance of screening for housing needs and supporting systemic changes to advance equitable access to care. Additional research is needed to develop and test provider- and policy-level housing interventions that can effectively address the needs of individuals throughout the cancer care continuum.
在美国，稳定且负担得起的住房是健康的重要社会决定因素。然而，针对住房与癌症护理、诊断和结果的研究尚未得到综合。
我们使用 PubMed、Embase、Scopus 和 CINAHL 对研究进行了系统综述，这些研究检查了住房与癌症护理和结果之间的关联。纳入的研究在美国进行，发表于 1980 年至 2021 年期间，使用英语。提取了研究特征和主要发现，并进行了定性综合。
共确定了 31 项研究。20 项研究（65%）报告了个体层面的住房相关措施，11 项研究（35%）报告了区域层面的住房相关措施。研究人群和住房措施具有异质性。最常见的住房措施是区域层面的住房歧视（8 项研究，26%）、个体层面的住房状况（8 项研究，26%）和个体层面的住房问题（7 项研究，23%）。最常见的癌症结果是筛查（12 项研究，39%）和死亡率（9 项研究，29%）。很少有研究评估了住房的多个维度。大多数研究发现，住房无保障的暴露与癌症护理（11 项研究）或结果（10 项研究）更差具有统计学显著相关性。
住房不安全与癌症护理和结果呈负相关，这突显了筛查住房需求和支持系统变革以促进公平获得护理的重要性。需要进一步研究来开发和测试针对个人的住房干预措施和政策层面的住房干预措施，以有效满足整个癌症护理过程中个人的需求。
