Severe housing cost burden and premature mortality from cancer.

Abstract

Unaffordable housing has been associated with poor health. We investigated the relationship between severe housing cost burden(SHCB) and premature cancer mortality (death <65 years) overall and by Medicaid expansion status. County-level SHCB was measured by percentage of households that spend ≥50% of their income on housing. States were classified based on Medicaid expansion status (expanded, late-expanded, non-expanded). Adjusted-mortality rate ratios (aRRs) were estimated by cancer type across SHCB quintiles. Compared to the lowest quintile of SHCB, counties in the highest quintile had a 5% greater cancer mortality rate (aRR = 1.05, 95%CI 1.01-1.08). Within each SHCB quintile, cancer mortality rates were greater in states that did not expand Medicaid, though this association was only significant in the fourth quintile of SHCB (aRR = 1.08; 95% CI 1.03-1.13). Our findings demonstrate that counties with greater SHCB had higher premature cancer death rates, and rates are potentially greater in non-Medicaid expanded states than Medicaid expanded states.