Housing and utility hardship among adults with gastrointestinal cancer: differences by housing tenure and employment status.

BACKGROUND

Financial hardship is common in cancer care and may extend beyond medical costs to threaten basic needs, such as housing and utilities. Nationally representative data comparing the inability to pay mortgage, rent, or utility bills and threatened utility shutoff among adults with gastrointestinal (GI) cancer versus adults without GI cancer are limited.

METHODS

We analyzed 2022 to 2023 Behavioral Risk Factor Surveillance System data for adults aged ≥18 years. GI cancer history and treatment status were identified using Cancer Survivorship Module items and were categorized as no GI cancer, current treatment, or treatment completed. Outcomes included inability to pay mortgage, rent, or utility bills and threatened utility shutoff during the previous 12 months. Survey-weighted multivariable models were adjusted for demographic and socioeconomic factors and were stratified by employment status and housing tenure.

RESULTS

Among 63,753 adults, 1870 (3.0%) reported GI cancer, including 420 (0.7%) undergoing current treatment and 1450 (2.3%) with completed treatment. Inability to pay mortgage, rent, or utility bills was reported by 88 (21.0%) of those undergoing current treatment and 215 (14.8%) of those with completed treatment, compared with 5100 (8.2%) of adults without GI cancer (P = .01). Threatened utility shutoff was reported by 55 (13.1%) and 145 (10.0%), respectively, versus 3600 (5.8%) among adults without GI cancer (P = .02). Among renters who were unemployed, current GI cancer treatment was associated with higher odds of inability to pay mortgage, rent, or utility bills (adjusted odds ratio [aOR], 3.40; 95% CI, 2.20-5.40) and threatened utility shutoff (aOR, 3.30; 95% CI, 2.30-4.90), compared with renters without GI cancer.

CONCLUSION

Self-reported GI cancer, particularly current treatment, was associated with an elevated inability to pay mortgage, rent, or utility bills and threatened utility shutoff, with the highest burden among renters who were unemployed.