People experiencing homelessness face inpatient care disparities

Abstract

When Patricia Santos, MD, was a medical resident in radiation oncology at Memorial Sloan Kettering Cancer Center (MSKCC) in New York, she and her colleagues observed the numerous challenges that people experiencing homelessness (PEH) face after a cancer diagnosis.

“A number of us who were doing work in this space had our own individual stories of what we saw on a one-on-one basis, but we found very little literature on what that actually meant for cancer care delivery and services among the unhoused,” says Dr Santos, now an assistant professor of radiation oncology at Emory University School of Medicine in Atlanta, Georgia.

She practices at Atlanta’s Grady Memorial Hospital, one of the largest public safety net hospitals in the country.

Setting out to learn more while still at MSKCC, she and her colleagues launched a study that was published in JAMA Oncology (doi:10.1001/jamaoncol.2024.3645). This large cross-sectional study of hospitalized US adults diagnosed with cancer found that PEH had higher prevalences of lung and upper gastrointestinal cancers along with comorbid substance use disorder and HIV. Despite these diagnoses and longer hospital stays, these individuals were less likely to undergo invasive procedures or systemic therapy or have higher-than-median costs of stay than housed populations. Homelessness was associated with a lower rate of death while a patient was in the hospital. However, PEH were found to be 4 times more likely to be discharged against medical advice.

Using the 2016–2020 National Inpatient Sample, the cross-sectional study assessed hospitalized inpatient adults aged 18 years or older who were diagnosed with cancer. Researchers developed a cohort of PEH and housed individuals who were matched according to age, sex, race, ethnicity, insurance type, cancer diagnosis, number of comorbidities, substance abuse disorder, severity of illness, year of admission, hospital location, hospital ownership, region, and hospital bed size.

The study included 13,793,462 housed individuals (median age, 68 years) and 45,150 PEH (median age, 58 years).