Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2025
Surgical outcomes among individuals experiencing homelessness with gastrointestinal cancer.
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Mevawalla Areesh, Rashid Zayed, Khalil Mujtaba, Altaf Abdullah, Zindani Shahzaib, Sarfraz Azza, Chatzipanagiotou Odysseas P, King Jasmine, Shaw Shreya, Pawlik Timothy M
Аннотация
BACKGROUND: The number of people experiencing homelessness has increased drastically in recent years, and cancer remains a leading cause of death among this population. Therefore, the current study aimed to investigate the receipt of gastrointestinal (GI) cancer treatment and outcomes among people experiencing homelessness.
METHODS: Patients diagnosed with GI cancer were identified using the National Inpatient Sample database (2016-2019). Entropy balancing was performed to create a well-balanced cohort, and multivariate regression was used to assess the association of housing status with the receipt of treatment and other outcomes of interest.
RESULTS: Among 1,835,005 individuals diagnosed with GI cancer, 5380 experienced homelessness. Younger individuals (58 years [IQR, 53-64] vs 67 years [IQR, 58-76]), males (81.5% vs 56.0%), and black individuals (25.4% vs 13.4%) were more likely to experience homelessness (all P <.001). Compared with housed individuals, people experiencing homelessness were less likely to undergo surgery (23.0% vs 9.0%, respectively) and were more likely to experience an extended inpatient stay (5 days [IQR, 3-8]) vs 6 days [IQR, 3-11]) (both P <.05). On multivariate analysis, homelessness was associated with higher odds of extended length of hospital stay (mean difference: 3.33 days [95% CI, 2.60-4.10]) and discharge against medical advice (odds ratio, 6.86 [95% CI, 5.50-8.55]). In addition, patients experiencing homelessness incurred higher healthcare costs (mean difference: $3853 [95% CI, $1939-$5767]).
CONCLUSION: Patients experiencing homelessness were less likely to undergo surgery and had suboptimal outcomes. The disparity in treatment should be addressed to ensure equitable care and to reduce the financial burden for this population.
METHODS: Patients diagnosed with GI cancer were identified using the National Inpatient Sample database (2016-2019). Entropy balancing was performed to create a well-balanced cohort, and multivariate regression was used to assess the association of housing status with the receipt of treatment and other outcomes of interest.
RESULTS: Among 1,835,005 individuals diagnosed with GI cancer, 5380 experienced homelessness. Younger individuals (58 years [IQR, 53-64] vs 67 years [IQR, 58-76]), males (81.5% vs 56.0%), and black individuals (25.4% vs 13.4%) were more likely to experience homelessness (all P <.001). Compared with housed individuals, people experiencing homelessness were less likely to undergo surgery (23.0% vs 9.0%, respectively) and were more likely to experience an extended inpatient stay (5 days [IQR, 3-8]) vs 6 days [IQR, 3-11]) (both P <.05). On multivariate analysis, homelessness was associated with higher odds of extended length of hospital stay (mean difference: 3.33 days [95% CI, 2.60-4.10]) and discharge against medical advice (odds ratio, 6.86 [95% CI, 5.50-8.55]). In addition, patients experiencing homelessness incurred higher healthcare costs (mean difference: $3853 [95% CI, $1939-$5767]).
CONCLUSION: Patients experiencing homelessness were less likely to undergo surgery and had suboptimal outcomes. The disparity in treatment should be addressed to ensure equitable care and to reduce the financial burden for this population.