Inpatient Care and Outcomes Among People With Cancer Experiencing Homelessness

Area of Science:

• Oncology
• Health Services Research
• Health Equity

Background:

• Cancer is a leading cause of death for people experiencing homelessness (PEH) in the US.
• Acute care settings are crucial for PEH, but housing status's impact on cancer inpatient care is understudied.

Purpose of the Study:

• To assess the association between housing status and inpatient care for hospitalized adults with cancer.
• To identify disparities in cancer care delivery based on housing status.

Main Methods:

• Cross-sectional study using 2016-2020 National Inpatient Sample data.
• Included hospitalized adults aged 18+ with cancer.
• Propensity score matching (1:1 nearest neighbor) created cohorts of PEH and housed individuals, matched on numerous demographic, clinical, and hospital characteristics.

Main Results:

• The PEH cohort had higher rates of certain cancers, substance use disorder, and illness severity.
• PEH were less likely to receive invasive procedures (AOR, 0.53) or systemic therapy (AOR, 0.73).
• PEH had lower inpatient death rates (AOR, 0.79) but were significantly more likely to be discharged against medical advice (AMA) (AOR, 4.29).

Conclusions:

• Significant disparities exist in the inpatient cancer care received by people experiencing homelessness.
• Findings highlight critical opportunities to improve equitable cancer care for this vulnerable population.
• Addressing housing status is essential for reducing cancer care inequities.