Mevawalla Areesh, Rashid Zayed, Khalil Mujtaba, Altaf Abdullah, Zindani Shahzaib, Sarfraz Azza, Chatzipanagiotou Odysseas P, King Jasmine, Shaw Shreya, Pawlik Timothy M
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, United States.
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, United States.
J Gastrointest Surg. 2025 Aug;29(8):102110. doi: 10.1016/j.gassur.2025.102110. Epub 2025 Jun 3.
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.
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.
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]).
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.
近年来，无家可归者的数量急剧增加，癌症仍然是这一人群的主要死因。因此，本研究旨在调查无家可归者接受胃肠道（GI）癌症治疗的情况及治疗结果。
使用国家住院样本数据库（2016 - 2019年）识别诊断为胃肠道癌症的患者。进行熵平衡以创建一个均衡的队列，并使用多变量回归评估住房状况与治疗接受情况及其他感兴趣结果之间的关联。
在1,835,005名诊断为胃肠道癌症的个体中，5380人无家可归。较年轻的个体（58岁[四分位间距，53 - 64岁]对比67岁[四分位间距，58 - 76岁]）、男性（81.5%对比56.0%）和黑人个体（25.4%对比13.4%）更有可能无家可归（所有P <.001）。与有住房的个体相比，无家可归者接受手术的可能性较小（分别为23.0%对比9.0%），且住院时间延长的可能性更大（5天[四分位间距，第3 - 8天]对比6天[四分位间距，第3 - 11天]）（两者P <.05）。多变量分析显示，无家可归与住院时间延长的几率较高（平均差异：3.33天[95%置信区间，从2.60至4.10天]）以及违反医嘱出院（比值比，6.86[95%置信区间，5.50 - 8.55]）相关。此外，无家可归的患者产生了更高的医疗费用（平均差异：3853美元[95%置信区间，1939美元至5767美元]）。
无家可归的患者接受手术的可能性较小，且治疗结果欠佳。应解决治疗方面的差异，以确保公平医疗并减轻这一人群的经济负担。
