S439 Epidemiology of Homelessness Among Hospitalized Patients With Colon Cancer: A Population-Level Analysis

Introduction: Homeless individuals face poor health and limited access to healthcare, often compounded by mental health issues and substance use disorders. Despite elevated cancer risk, they remain underrepresented in research. Homelessness (HL) has been linked to later-stage colorectal cancer diagnoses and higher mortality. To address this gap, we conducted a population-level epidemiological study examining cancer characteristics and risk factors in this vulnerable group. Methods: We conducted a population-based cohort study using deidentified, statewide data on adults (≥18 years) hospitalized to acute care hospitals with colon cancer in Texas from 2016–2022, identified using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes C18x and C20 selected from Clinical Classification Software Refined (CCSR) category “NEO015: Gastrointestinal cancers - colorectal.” The primary exposure was a diagnosis of HL identified using ICD-10-CM codes selected from CCSR category “FAC0190: Socioeconomic/psychosocial factors”, and the primary outcome was length of stay. Short-term mortality was defined as in-hospital death or discharge to hospice. Overlap propensity score weighting was used, with results reported as adjusted risk ratios and 95% confidence intervals (CIs). Secondary outcomes included discharge against medical advice (AMA). Results: Among 127,127 hospitalizations for colon cancer, 396 (<0.3%) involved individuals experiencing HL. Compared to others, HL patients were younger, more often Black (29.6% vs 12.5%, P < 0.0001), uninsured (32.5% vs 8.5%, P < 0.0001) or on Medicaid (32.0% vs 6.1%, P < 0.0001), and had higher rates of mental illness, substance use (opioids 6.1%, cannabis 8.3%, stimulants 20.2%, P < 0.0001), and HIV (5.1% vs 0.4%, P < 0.0001), but lower diabetes prevalence. They had longer hospital stays (mean 10.2 vs 6.5 days) and were more likely to leave AMA (7.8% vs 0.6%). Adjusted analysis showed HL was associated with increased length of stay (aRR 1.35, 95% CI 1.19–1.54) and AMA discharge (aRR 3.20, 95% CI 2.14–4.79). Conclusion: Structural barriers to colonoscopy access heighten colorectal cancer risk and hinder follow-up care among individuals experiencing homelessness, leading to longer hospital stays and higher AMA discharges. Limited research on patient perspectives limits policy development. Addressing these disparities requires integrated interventions combining stable housing with comprehensive healthcare, expanded colonoscopy screening access, and broader societal efforts targeting root causes of health disparities.