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.
背景/目的：健康的社会决定因素（SDOHs）对癌症患者的急诊依赖具有显著影响。方法：为更好地预测SDOHs对无家可归转移性癌症患者急诊入院的影响程度，本研究采用机器学习模型（Lasso回归、岭回归、随机森林及弹性网络回归）进行分析。同时针对前列腺癌、乳腺癌、肺癌及唇/口腔/咽部癌症患者，重点考察无家可归与独居这两个关键SDOH变量与临床结局的关联性。通过建立广义线性模型，在控制患者及临床特征的前提下评估其相关性。本研究数据来源于美国国家住院患者样本数据库。结果：共纳入2635例（加权后）无家可归的转移性癌症患者。是否从其他机构转入、是否为择期入院、缺铁性贫血、酒精依赖、是否周末入院及失血性贫血是急诊入院的重要预测因子。各模型C统计量分别为：Lasso回归（训练集AUC=0.85；测试集AUC=0.86）、岭回归（0.85，0.88）、随机森林（0.96，0.85）及弹性网络（0.83，0.80）。校正分析显示，无家可归的前列腺癌患者与焦虑抑郁（OR=5.15，95% CI：3.17-8.35）及住院时间延长（OR=1.96；95% CI：1.03-3.74）显著相关。乳腺癌、肺癌及唇/口腔/咽部癌症队列呈现相似趋势。SDOHs状况不佳的癌症患者临床结局最差。结论：SDOHs不良的癌症患者临床结局最不理想。本研究揭示了当前癌症研究领域的空白，并强调社会支持对改善预后及提升生活质量的重要价值。
肿瘤(癌症)患者之家