Impact of homelessness on outcomes among pancreatic cancer hospitalization: Insight from the 2016-2020 National Inpatient Sample.

Authors

null

Alekhya Pagidipally

Kamineni Academy of Medical Sciences and Research Centre, NTRUHS, Hyderabad, India

Alekhya Pagidipally , Shivani Sharma , Mehndi Dandwani , Suma Sri Chennapragada , Kamleshun Ramphul , Renuka Verma , Sailaja Sanikommu , Shaheen Sombans , Stephanie G Mejias , Balkiranjit Kaur Dhillon , Petras Lohana , Fnu Arti , Vijay Kumar

Organizations

Kamineni Academy of Medical Sciences and Research Centre, NTRUHS, Hyderabad, India, Louisiana State University Shreveport, Shreveport, LA, Danbury Hospital, Yale Affiliated Hospitals Program, Danbury, CT, LSU Health Shreveport, Shreveport, LA, Independent Researcher, Triolet, Mauritius, Raj Multispeciality Hospital, Mohali, India, Sri Manakula Vinayagar Med college and Hosp, Puducherry, India, Bharati Vidyapeeth Univ Med College and Hosp, Hyderabad, India, Independent Researcher, Santo Domingo, Dominican Republic, Independent Researcher, Brampton, ON, Canada, Jacobi Medical Centre, Bronx, NY, MedStar Health, Columbia, MD, University of Mississippi Medical Center, Mississippi

Research Funding

No funding received
None.

Background: Homelessness is a major socio-economic issue in the United States, affecting an estimated 171 per 100,000 persons in certain states. While pancreatic cancer (PC) tends to have a poor prognosis, the disease requires an early diagnosis, proper care, and follow-ups. As there is a paucity of data highlighting differences in patient characteristics and outcomes of homeless patients with PC, a retrospective study was conducted via a national database. Methods: We used data from the 2016-2020 National Inpatient Sample (NIS), the most extensive hospital database, to identify patients with a diagnosis of pancreatic cancer. Patients with a status of “homeless” were located via the ICD-10 code “Z590”, per suggestions from HCUP and past studies. Several differences in patient characteristics were explored between homeless cases of PC and non-homeless cases via Pearson’s Chi-Square tests. Finally, the adjusted odds ratio (aOR) and 95% Confidence intervals (CI) of various outcomes such as mortality, pulmonary embolism, septicemia, and hepatic failure were calculated via multivariable logistic regression models. Results: Our study identified 544855 pancreatic cancer cases, including 1380 patients classified as homeless (0.3%). 81.5% of homeless patients were males (vs. 52.1%), and 24.6% were admitted on weekends (vs. 20.6%). Moreover, Medicaid was the prime insurer among homeless patients (47.6% vs. 8.6%) with a higher mean hospital charge ($86796 vs. $70610). Racial differences were also observed as 51.9% of homeless cases were Whites (vs. 71.2%), while 31.6% (vs. 13.8%) were Blacks, and 11.3% (vs. 8.2%) were Hispanics. A higher proportion of homeless cases had palliative care utilization (27.9% vs. 19.1%), a Do-Not-Resuscitate (DNR) order (25.7% vs. 23.1%), and required pancreatic and proximal biliary dilation/stenting (4.0% vs. 2.2%). Homeless patients admitted with pancreatic cancer also expressed higher odds of in-hospital mortality (8.7% vs. 7.4%, aOR 1.625, 95% CI 1.280-2.064, p<0.01). No statistical significance was found for events of pulmonary embolism (aOR 1.231, p=0.160), septicemia (aOR 1.044, p=0.674), and hepatic failure (aOR 0.892, p=0.549). Conclusions: Homeless patients with PC were linked with higher in-patient mortality. Various racial and socio-economic differences were also observed. Several efforts to ameliorate access to care among homeless patients and an early diagnosis may help improve the outcomes.

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Abstract Details

Meeting

2023 ASCO Annual Meeting

Session Type

Publication Only

Session Title

Publication Only: Gastrointestinal Cancer—Gastroesophageal, Pancreatic, and Hepatobiliary

Track

Gastrointestinal Cancer—Gastroesophageal, Pancreatic, and Hepatobiliary

Sub Track

Pancreatic Cancer - Advanced/Metastatic Disease

Citation

J Clin Oncol 41, 2023 (suppl 16; abstr e16264)

DOI

10.1200/JCO.2023.41.16_suppl.e16264

Abstract #

e16264

Abstract Disclosures

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