ImportanceCancer is a leading cause of death among people experiencing homelessness (PEH) in the US. Acute care settings are important sources of care for PEH; however, the association of housing status with inpatient care remains understudied, particularly in the context of cancer.ObjectiveTo assess whether housing status is associated with differences in the inpatient care of hospitalized adults with cancer.Design, Setting, and ParticipantsThis cross-sectional study included hospitalized inpatient adults aged 18 years or older diagnosed with cancer who were identified using data from the 2016 to 2020 National Inpatient Sample. Propensity score matching was used to create a cohort of PEH and housed individuals matched according to age, sex, race and ethnicity, insurance type, cancer diagnosis, number of comorbidities, substance use disorder, severity of illness, year of admission, hospital location, hospital ownership, region, and hospital bed size. Matched pairs were identified using a 1:1 nearest neighbor matching algorithm without replacement, accounting for survey weights. Data were analyzed from August 1, 2022, to April 30, 2024.ExposureHousing status.Main Outcomes and MeasuresThe associations of receipt of invasive procedures, systemic therapy, or radiotherapy during hospitalization (primary outcomes) as well as inpatient death, high cost of stay, and discharge against medical advice (AMA) (secondary outcomes) with housing status. Odds ratios and 95% CIs were estimated with multivariable logistic regression, with adjustment for patient, disease, and hospital characteristics of the matched cohort.ResultsThe unmatched cohort comprised 13 838 612 individuals (median [IQR] age, 67 [57-76] years; 7 329 473 males [53.0%]) and included 13 793 462 housed individuals (median [IQR] age, 68 [58-77] years) and 45 150 (median [IQR] age, 58 [52-64] years) individuals who were experiencing homelessness after accounting for survey weights. The PEH cohort had a higher prevalence of lung (17.3% vs 14.5%) and upper gastrointestinal (15.2% vs 10.5%) cancers, comorbid substance use disorder (70.2% vs 15.3%), and HIV (5.3% vs 0.5%). Despite having higher rates of moderate or major illness severity (80.1% vs 74.0%) and longer length of stay (≥5 days: 62.2% vs 49.1%), PEH were less likely to receive invasive procedures (adjusted odds ratio [AOR], 0.53; 95% CI, 0.49-0.56), receive systemic therapy (AOR, 0.73; 95% CI, 0.63-0.85), or have a higher-than-median cost of stay (AOR, 0.71; 95% CI, 0.65-0.77). Although PEH had lower rates of inpatient death (AOR, 0.79; 95% CI, 0.68-0.92), they were 4 times more likely to be discharged AMA (AOR, 4.29; 95% CI, 3.63-5.06).Conclusions and RelevanceIn this nationally representative cross-sectional study of hospitalized adults with cancer, disparities in inpatient care of PEH highlight opportunities to promote equitable cancer care in this socioeconomically vulnerable population.

中文翻译：

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无家可归癌症患者的住院护理和结果


重要性癌症是美国无家可归者 （PEH） 的主要死因。急性护理机构是 PEH 的重要护理来源;然而，住房状况与住院护理的关系仍未得到充分研究，尤其是在癌症的情况下。目的评估住房状况是否与住院成人癌症患者的住院护理差异相关。设计、设置和参与者这项横断面研究包括使用 2016 年至 2020 年全国住院样本的数据确定的 18 岁或以上被诊断患有癌症的住院成人。倾向评分匹配用于创建根据年龄、性别、种族和民族、保险类型、癌症诊断、合并症数量、物质使用障碍、疾病严重程度、入院年份、医院位置、医院所有权、地区和医院床位大小进行匹配的 PEH 和住房个体队列。使用 1：1 最近邻匹配算法识别匹配的对，无需替换，考虑调查权重。数据分析时间为 2022 年 8 月 1 日至 2024 年 4 月 30 日。主要结局和措施住院期间接受侵入性手术、全身治疗或放疗（主要结局）以及住院死亡、高住院费用和违背医疗建议出院 （AMA）（次要结局）与住房状况的关联。通过多变量 logistic 回归估计比值比和 95% CI，并调整匹配队列的患者、疾病和医院特征。结果不匹配的队列包括 13 838 612 人 （中位 [IQR] 年龄，67 [57-76] 岁;7 329 473 名男性 [53.0%]），并包括 13 793 462 名无家可归者 （中位 [IQR] 年龄，68 [58-77] 岁）和 45 150 名 （中位 [IQR] 年龄，58 [52-64] 岁）在考虑调查权重后无家可归。PEH 队列的肺癌 （17.3% 对 14.5%） 和上消化道癌 （15.2% 对 10.5%） 、共病物质使用障碍 （70.2% 对 15.3%） 和 HIV （5.3% 对 0.5%） 的患病率较高。尽管中度或重度疾病严重程度的发生率较高（80.1% 对 74.0%）和住院时间较长（≥5 天：62.2% 对 49.1%），但 PEH 接受侵入性手术的可能性较小（校正比值比 [AOR]，0.53;95% CI，0.49-0.56），接受全身治疗（AOR，0.73;95% CI，0.63-0.85）或高于住院成本中位数（AOR，0.71;95% CI， 0.65-0.77）。尽管 PEH 的住院死亡率较低 （AOR， 0.79;95% CI， 0.68-0.92），但他们出院 AMA 的可能性是 4 倍 （AOR， 4.29;95% CI， 3.63-5.06）。结论和相关性在这项针对住院成人癌症的具有全国代表性的横断面研究中，PEH 住院护理的差异突出了在这个社会经济弱势群体中促进公平癌症护理的机会。