Assessing Brain Tumor Outcomes in Patients Experiencing Homelessness: A Nationwide Retrospective Cohort Study

Introduction: Homelessness, driven by poverty and housing instability, can greatly affect access to timely care and treatment outcomes. This study examined the association between homelessness and key hospital outcomes in patients with brain tumors, including elective admissions, surgical interventions, hospital length of stay (LOS), total associated costs and discharge status (routine vs non-routine).

Methods: This retrospective cohort study utilized data from the Nationwide Inpatient Sample (NIS) for 2016 and 2020. A total of 370 patients were included after 1:1 propensity score matching (185 patients experiencing homeless and 185 not experiencing homeless patients). Multivariable logistic regression was used to assess the likelihood of elective admission, surgical intervention, and discharge destination, while gamma regression with a log link was employed to analyze differences in LOS and total associated costs.

Results: Compared to patients not experiencing homelessness, those experiencing homelessness were 89% more likely to be admitted non-electively (aOR 0.11, 95% CI 0.04-0.32, P< 0.001) and 60% less likely to undergo surgical intervention (aOR 0.40, 95% CI 0.20-0.79, P=0.008). Patients experiencing homeless also had a 2.16-fold longer hospital stay than those not experiencing homeless (β = -0.77, P< 0.001). Additionally, patients experiencing homelessness were 79% less likely to be discharged to a short-term facility, skilled nursing facility, or home health care (aOR 0.21, 95% CI 0.10-0.45, P< 0.001). On average, the cost of care for patients experiencing homelessness was 11.37 times higher than that of patients in stable housing (β = -2.43, P< 0.001).

Conclusion : Patients experiencing homelessness face significant disparities in healthcare outcomes, including higher rates of non-elective admissions, lower likelihood of undergoing surgical interventions, and prolonged hospital stays. Additionally, they are less likely to be discharged to certain post-acute care settings and incur substantially higher healthcare costs. These findings highlight the need for targeted interventions to address the unique healthcare challenges faced by homeless and housing insecure populations to reduce the associated healthcare burden.