e13755 Background: Homelessness significantly impacts health, contributing to worse cancer outcomes and higher death rates. However, national cancer datasets usually don't include housing status. This study utilized location of death as a proxy for housing instability to assess demographic patterns and trends in lung cancer mortality among potentially homeless individuals in the United States. Methods: We conducted a retrospective population-level study using CDC WONDER Multiple Cause of Death data from 1999 to 2020, focusing on adults aged 25 and older. Lung cancer deaths were identified using the ICD-10 code C34. Deaths that occurred in "other," "public place," "dead on arrival," or "unknown" settings were considered deaths that indicated homelessness. We calculated age-adjusted and crude mortality rates, separating the data by race, sex, and age. We used linear regression to find trends over time. We used multivariable logistic regression to determine the odds of death in homeless-proxy settings, using American Indian/Alaska Native populations as a comparison group. The CDC WONDER database did not have information on late-stage cancer, which limited direct comparisons of cancer stages. Results: Among the 3.36 million lung cancer deaths, 59,680 (1.8%) were in homeless-proxy settings, a number that increased from 45.3% in 1999 to 66.7% in 2020 (p < 0.001). The largest group of deaths was in adults aged 45–64. Age-adjusted mortality rates in “other” settings were highest in White individuals (76.7/100,000), followed by Black (41.3/100,000) and Asian/Pacific Islander individuals (38.0/100,000). In regression models, odds of dying in homeless-proxy settings were highest in Black (OR 2.94, 95% CI 2.85–3.04), White (OR 2.51, 95% CI 2.43–2.59), and Asian/Pacific Islander (OR 1.84, 95% CI 1.72–1.96) individuals relative to American Indian/Alaska Natives. Although the total death rates were higher for Whites, the adjusted odds ratio shows the chances of dying in a homeless-proxy setting for each group, rather than overall population rates, which clarifies the seeming difference. Conclusions: Lung cancer mortality in potentially homeless individuals is rising, with significant racial disparities and a burden concentrated in middle-aged adults. Policy and care delivery frameworks must recognize housing instability as a critical component of cancer outcomes. Integrated oncology-housing interventions are urgently needed to reduce structural inequities and support at-risk populations.
Ako et al. (Thu,) studied this question.