无家可归的癌症患者的住院治疗和结果

癌症是美国无家可归者（PEH）的主要死因。急症护理机构是无家可归者接受护理的重要来源；然而，住房状况与住院护理之间的关系仍未得到充分研究，尤其是在癌症方面。

To assess whether housing status is associated with differences in the inpatient care of hospitalized adults with cancer.

评估住房状况是否与成人癌症患者住院治疗的差异有关。

This 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.

这项横断面研究包括年龄在 18 周岁或以上、确诊患有癌症的住院成人，他们是通过 2016 年至 2020 年全国住院病人抽样调查数据确定的。研究采用倾向得分匹配法，根据年龄、性别、种族和民族、保险类型、癌症诊断、合并症数量、药物使用障碍、病情严重程度、入院年份、医院位置、医院所有权、地区和医院床位规模，创建 PEH 和住院患者队列。在考虑调查权重的情况下，使用 1:1 近邻匹配算法确定匹配对，不进行替换。数据分析时间为 2022 年 8 月 1 日至 2024 年 4 月 30 日。

Housing status.

住房状况。

The 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.

住院期间接受侵入性手术、系统性治疗或放疗（主要结果）以及住院患者死亡、住院费用高昂和违反医嘱出院（次要结果）与住房状况的关系。通过多变量逻辑回归估算出患病率和 95% CI，并对匹配队列的患者、疾病和医院特征进行了调整。

The 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).

非匹配队列由 13 838 612 人组成（中位数[IQR]年龄为 67 [57-76] 岁；7 329 473 名男性[53.0%]），其中包括 13 793 462 名有住房的人（中位数[IQR]年龄为 68 [58-77] 岁）和 45 150 名无家可归的人（中位数[IQR]年龄为 58 [52-64] 岁）。PEH 组群的肺癌（17.3% 对 14.5%）和上消化道癌（15.2% 对 10.5%）患病率、合并药物使用障碍（70.2% 对 15.3%）和 HIV（5.3% 对 0.5%）患病率均较高。尽管 PEH 患中度或重度疾病的比例较高（80.1% vs 74.0%），住院时间较长（≥5 天：62.2% vs 49.1%），但接受侵入性手术（调整后的几率比 [AOR]，0.53；95% CI，0.49-0.56）、接受系统治疗（AOR，0.73；95% CI，0.63-0.85）或住院费用高于中位数（AOR，0.71；95% CI，0.65-0.77）的可能性较低。虽然 PEH 的住院病人死亡率较低（AOR，0.79；95% CI，0.68-0.92），但他们出院时接受急性病治疗的可能性要高出 4 倍（AOR，4.29；95% CI，3.63-5.06）。

In 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.

在这项针对住院成人癌症患者的具有全国代表性的横断面研究中，PEH 住院治疗的差异凸显了在这一社会经济弱势人群中促进公平癌症治疗的机会。