PT - JOURNAL ARTICLE AU - Decker, Hannah AU - Colom, Sara AU - Evans, Jennifer L AU - Graham-Squire, Dave AU - Perez, Kenneth AU - Kushel, Margot AU - Wick, Elizabeth AU - Raven, Maria C AU - Kanzaria, Hemal K TI - Association of housing status and cancer diagnosis, care coordination and outcomes in a public hospital: a retrospective cohort study AID - 10.1136/bmjopen-2024-088303 DP - 2024 Sep 01 TA - BMJ Open PG - e088303 VI - 14 IP - 9 4099 - http://bmjopen.bmj.com/content/14/9/e088303.short 4100 - http://bmjopen.bmj.com/content/14/9/e088303.full SO - BMJ Open2024 Sep 01; 14 AB - Objectives Cancer is a leading cause of death in unhoused adults. We sought to examine the association between housing status, stage at diagnosis and all-cause survival following cancer diagnosis at a public hospital.Design Retrospective cohort study examining new cancer diagnoses between 1 July 2011 and 30 June 2021.Setting A public hospital in San Francisco.Exposure Housing status (housed, formerly unhoused, unhoused) was ascertained via a county-wide integrated dataset that tracks both observed and reported homelessness.Methods We reported univariate analyses to investigate differences in demographic and clinical characteristics by housing group. We then constructed Kaplan-Meier curves stratified by housing group to examine unadjusted all-cause mortality. Finally, we used multivariable Cox proportional hazards models to compare the hazard rate of mortality for each housing status group, adjusting for demographic and clinical factors.Results Our cohort included 5123 patients with new cancer diagnoses, with 4062 (79%) in housed patients, 623 (12%) in formerly unhoused patients and 438 (9%) in unhoused patients. Unhoused and formerly unhoused patients were more commonly diagnosed with stage 4 disease (28% and 27% of the time, respectively, vs 22% of housed patients). After adjusting for demographic and clinical characteristics, unhoused patients with stage 0–3 disease had a 50% increased hazard of death (adjusted HR (aHR) 1.5, 95% CI 1.1 to 1.9; p<0.004) as did formerly unhoused patients (aHR 1.5, 95% CI 1.2 to 1.9; p=0.001) compared with housed individuals 3 months after diagnosis.Conclusions Unhoused and formerly unhoused patients diagnosed with non-metastatic cancer had substantially increased hazards of death compared with housed patients cared for in a public hospital setting. Current or former lack of housing could contribute to poor outcomes following cancer diagnoses via multiple mechanisms.No data are available. This dataset contains sensitive information including housing status, interaction with the criminal justice system, behavioural health system, and more, and cannot be publicly shared.