Individual-level home values and cancer mortality in a statewide registry

Abstract

Background: Prior work assessing disparities in cancer outcomes has relied on regional socioeconomic metrics. These metrics average data across many individuals, resulting in a loss of granularity and confounding with other regional factors.

Methods: Using patients' addresses at the time of diagnosis from the Ohio Cancer Incidence Surveillance System, we retrieved individual home price estimates from an online real estate marketplace. This individual-level estimate was compared with the Area Deprivation Index (ADI) at the census block group level. Multivariable Cox proportional hazards models were used to determine the relationship between home price estimates and all-cause and cancer-specific mortality.

Results: A total of 667 277 patients in Ohio Cancer Incidence Surveillance System were linked to individual home prices across 16 cancers. Increasing home prices, adjusted for age, stage at diagnosis, and ADI, were associated with a decrease in the hazard of all-cause and cancer-specific mortality (hazard ratio [HR] = 0.92, 95% confidence interval [CI] = 0.92 to 0.93, and HR = 0.95, 95% CI = 0.94 to 0.95, respectively). Following a cancer diagnosis, individuals with home prices 2 standard deviations above the mean had an estimated 10-year survival probability (7.8%, 95% CI = 7.2% to 8.3%) higher than those with home prices 2 standard deviations below the mean. The association between home price and mortality was substantially more prominent for patients living in less deprived census block groups (Pinteraction < .001) than for those living in more deprived census block groups.

Conclusion: Higher individual home prices were associated with improved all-cause and cancer-specific mortality, even after accounting for regional measures of deprivation.

Figure 1.

Study flow diagram. ADI = Area Deprivation Index; OCISS = Ohio Cancer Incidence Surveillance System.

Figure 2.

Distribution of home prices according to census block groups. Plot of individual home prices according to census block groups ranked by Area Deprivation Index (ADI). Red and yellow colors indicate home prices within a census block group. Darker shades of red indicate higher density of home prices within a particular census block group. Census block groups are ranked from lowest to highest (left to right) ADI.

Figure 3.

Overall relationship between hazard of mortality and home price. Unadjusted Cox models assessing the relationship between hazard of all-cause (A) and cancer-specific (B) mortality and home price for cancers of all stages combined. Home prices were log transformed and z scored and scaled. The model for all cancers combined included cancer site as a covariate. Shading indicates 95% confidence interval bands.

Figure 4.

Effect of area deprivation and home price on hazard of mortality. Hazard ratios from Cox models allowed for an interaction between home price and Area Deprivation Index (ADI) for all-cause (A) and cancer-specific (B) mortality in all cancers combined. Hazard ratios are plotted for ADI values 2 standard deviations above (blue) or below (green) the mean (red). Cox models were constructed with ADI as a continuous (linear) predictor along with home price, age at diagnosis, stage at diagnosis, and cancer site. Hazard ratios are given at the average age and localized stage at diagnosis and have been rescaled to make home price equal to zero and ADI equal to zero the referent. Outer borders of each line represent 95% confidence interval bands.