Evidence map›Paper›PMID 39266319›Full record

ArticleBMJ open2024

Association of housing status and cancer diagnosis, care coordination and outcomes in a public hospital: a retrospective cohort study.

Hannah Decker, Sara Colom, Jennifer L Evans, Dave Graham-Squire, Kenneth Perez, Margot Kushel, Elizabeth Wick, Maria C Raven, Hemal K Kanzaria

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In one paragraph

Article in BMJ open, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Hannah DeckerDepartment of Surgery, UCSF, San Francisco, California, USA.ORCID 0000-0003-0850-4134
Sara ColomBenioff Homelessness and Housing Initiative, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA.
Jennifer L EvansBenioff Homelessness and Housing Initiative, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA.
Dave Graham-SquireBenioff Homelessness and Housing Initiative, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA.
Kenneth PerezBenioff Homelessness and Housing Initiative, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA.
Margot KushelBenioff Homelessness and Housing Initiative, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA.
Elizabeth WickDepartment of Surgery, UCSF, San Francisco, California, USA Elizabeth.Wick@ucsf.edu.
Maria C RavenBenioff Homelessness and Housing Initiative, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA.
Hemal K KanzariaBenioff Homelessness and Housing Initiative, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesCancer 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.

designRetrospective cohort study examining new cancer diagnoses between 1 July 2011 and 30 June 2021.

settingA 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.

methodsWe 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.

resultsOur 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.

conclusionsUnhoused 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.

Indexed as

Hospitals, PublicHousingIll-Housed PersonsNeoplasmsAdultAgedFemaleHumansKaplan-Meier EstimateMaleMiddle AgedProportional Hazards ModelsRetrospective StudiesSan Franciscoadult oncologyhealth equitypatientspublic hospitals

Identifiers

PMID39266319
PMCPMC11404260

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LicenceCC BY-NC
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.