Is Gaining Housing Associated With Higher Rates of Cancer Screening Among US Veterans Experiencing Homelessness?

PURPOSE

People experiencing homelessness have lower rates of cancer screening than housed people, contributing to later stages at cancer diagnosis and poor outcomes. We examined whether gaining housing increased rates of cancer screening in a cohort of homeless veterans.

METHODS

We conducted a retrospective cohort study examining all veterans experiencing homelessness who were eligible for, but not up to date on, colorectal and breast cancer screening from 2011 to 2021. Our exposure was gaining housing in the 24 months after the index clinic visit, conceptualized as a time-varying covariate. Our primary outcome was undergoing breast or colorectal screening in the 24 months after that visit. We performed bivariate analysis and Cox proportional hazards analysis, clustering on the facility level and adjusting for clinical and demographic covariates.

RESULTS

Our cohort included 117,619 homeless veterans who were eligible for but not up to date on colorectal cancer screening at their index visit, of whom 57,705 (49.0%) gained housing over 24 months. The cohort included 6,517 homeless veterans who were eligible for but not up to date on breast cancer screening, of whom 3,101 (47.5%) gained housing over 24 months. Compared with peers who remained homeless, veterans who gained housing were more than twice as likely to undergo colorectal cancer screening (adjusted hazard ratio, 2.3; 95% CI, 2.2-2.3; <.001) and breast cancer screening (adjusted hazard ratio, 2.4; 95% CI, 2.2-2.7; <.001).

CONCLUSIONS

Veterans experiencing homelessness who gain housing have higher rates of cancer screening. This finding supports promotion of housing to improve health outcomes for homeless individuals.