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. 2025 Mar 27;17(7):1121.
doi: 10.3390/cancers17071121.

Predictors for Emergency Admission Among Homeless Metastatic Cancer Patients and Association of Social Determinants of Health with Negative Health Outcomes

Poolakkad S Satheeshkumar  1 , Stephen T Sonis  2 , Joel B Epstein  3 , Roberto Pili  1
Affiliations

Predictors for Emergency Admission Among Homeless Metastatic Cancer Patients and Association of Social Determinants of Health with Negative Health Outcomes

Poolakkad S Satheeshkumar et al. Cancers (Basel). .

Abstract

Background/objectives: Social determinants of health (SDOHs) are especially impactful with respect to emergency reliance among patients with cancer.

Methods: To better predict the extent to which SDOHs affect emergency admissions in homeless patients with metastatic disease, we employed machine learning models, Lasso, ridge, random forest (RF), and elastic net (EN) regression. We also examined prostate cancer (PC), breast cancer (BC), lung (LC) cancer, and cancers of the lip, oral cavity, and pharynx (CLOP) for association between key SDOH variables-homelessness and living alone-and clinical outcomes. For this, we utilized generalized linear models to assess the association while controlling for patient and clinical characteristics. We used the United States National Inpatient Sample database for this study.

Results: There were 2635 (weighted) metastatic cancer patients with homelessness. Transfer from another facility or not, elective admission or not, deficiency anemia, alcohol dependence, weekend admission or not, and blood loss anemia were the important predictors of emergency admission. C-statistics were associated with Lasso (train AUC-0.85; test AUC-0.86), ridge (85, 88), RF (0.96, 0.85), and EN (0.83, 0.80), respectively. In the adjusted analysis, PC homelessness was significantly associated with anxiety and depression (5.15, 95% CI: 3.17-8.35) and a longer LOS (1.96; 95% CI: 1.03-3.74). Findings were comparable in the BC, LC, and CLOP cohorts. Cancer patients with poor SDOHs presented with the worst clinical outcomes.

Conclusions: Cancer patients with poor SDOH presented with worst clinical outcomes. The findings of this study highlight a vacuum in the cancer literature, and the recommendations stress the value of social support in achieving a better prognosis and Quality of life.

Keywords: breast cancers; burden of illness; cancers of the lip, oral cavity, and pharynx; emergency admissions; homelessness; lung cancers; opioid abuse; problems related to living alone; prostate cancers; social determinants of health.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flowchart (flowchart of the cancer cohort selection; sample size presented with weighted (original patient numbers) and unweighted numbers).
Figure 2
Figure 2
ROC curve for prediction model.
Figure 3
Figure 3
XAI (explainable artificial intelligence)-based plot.
See this image and copyright information in PMC

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References

    1. [(accessed on 23 March 2023)]; Available online: https://health.gov/healthypeople/objectives-and-data/social-determinants....
    1. Penman-Aguilar A., Talih M., Huang D.P., Moonesinghe R.P., Bouye K., Beckles G.M. Measurement of Health Disparities, Health Inequities, and Social Determinants of Health to Support the Advancement of Health Equity. J. Public Health Manag. Pract. 2016;22:S33–S42. doi: 10.1097/PHH.0000000000000373. - DOI - PMC - PubMed
    1. Gottlieb L.M., Wing H., Adler N.E. A Systematic Review of Interventions on Patients’ Social and Economic Needs. Am. J. Prev. Med. 2017;53:719–729. doi: 10.1016/j.amepre.2017.05.011. - DOI - PubMed
    1. Meyer P.A., Penman-Aguilar A., Campbell V.A., Graffunder C., O’Connor A.E., Yoon P.W., Centers for Disease Control and Prevention (CDC) Conclusion and future directions: CDC Health Disparities and Inequalities Report—United States, 2013. MMWR Suppl. 2013;62:184–186. - PubMed
    1. Walter L.A., Schoenfeld E.M., Smith C.H., Shufflebarger E., Khoury C., Baldwin K., Hess J., Heimann M., Crosby C., Sontheimer S.Y., et al. Emergency department–based interventions affecting social determinants of health in the United States: A scoping review. Acad. Emerg. Med. 2020;28:666–674. doi: 10.1111/acem.14201. - DOI - PMC - PubMed

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