The effects of homelessness on lung cancer outcomes and costs in the Hungarian healthcare system

Abstract Background Differences in health risks, health service-seeking and healthcare access between people experiencing homelessness (PEH) and non-homeless patients are well-studied, but comprehensive estimates of the overall healthcare use and health outcome impacts are lacking for most countries. This study aims to address this gap for the Hungarian population where PEH have universal health coverage. Methods We analyzed data from the Hungarian national health insurance register between 2015 and 2021, including 11,857 PEH and a matched control population. A length index was created based on the duration of homelessness. PEH individuals were matched 1:5 with non-PEH controls. Kaplan-Meier survival curves and Cox proportional hazards regression (CPH) were estimated for those with lung cancer, adjusting for age, sex, and average healthcare costs. Results 641 patients were diagnosed with lung cancer, with a prevalence of 1.97% in the PEH group versus 0.69% in the control group. The degree of time spent in homelessness had the largest effect on the probability of death, with a hazard ratio (HR) of 1.47 (p < 0.05) overall and rising along the experienced length index. Average cumulative healthcare costs per patient were €3668 for PEH and €6827 for controls. The cost difference had a significant association with mortality (HR 0.97/1000€ p < 0.05). Conclusions PEH face a substantially higher lung cancer prevalence and have lower survival times alongside lower healthcare expenditure. The discrepancy in health outcomes, however, is not fully explained by differences in healthcare utilization. While even temporary homelessness increases health risks, longer-term homelessness has the most significant impact. Lifestyle-related factors could not be analyzed due to data limitations. Key messages • Homelessness severely affects lung cancer outcomes, with healthcare costs and survival analysis showing worse outcomes. • The duration of experienced homelessness plays a key role.