Differences in the lifestyle and health-service-seeking behavior of persons experiencing homelessness (PEH) are well known. However, a comprehensive estimation of the resulting healthcare utilization differences and health outcome impacts are so far under-researched, especially at the national level. We aim to close this gap of evidence for lung cancer within the Hungarian universal healthcare system. We analyzed lung cancer-related information for the PEH population in the Hungarian national central health insurance register dataset and a matched control population between 2015 and 2021. In this period, 11,857 people were registered as homeless for the majority of at least one year. To capture the effect of homelessness, we created a categorical “homelessness length index” (HLI) according to the proportion of time an individual experienced homelessness during the investigation period (HLI 0: 0; HLI 1: >0–1/3; HLI 2: >1/3–2/3; HLI 3: >2/3). PEH individuals were matched 1:5 with a non-PEH control sample adjusted for age, sex and region. We conducted Kaplan–Meier survival analysis and Cox proportional hazards (CPH) regression adjusted for age, sex, HLI and average lung cancer-related healthcare costs. Our final analysis sample consisted of 641 patients (233 PEH, 408 control) who were newly diagnosed with lung cancer during the observation period. The lung cancer prevalence in the PEH group was 1.97% as opposed to 0.69% in the control group. The Kaplan–Meier curve showed lower average survival times for the PEH group, compared to the control group. Lung cancer associated costs between diagnosis and death/censoring were substantially different with average per patient cumulative costs of EUR 3668 in the PEH group compared to EUR 6827 in the control group (2018 prices). This translated to an average 47% lower annual lung cancer-related healthcare cost per PEH patient. CPH analysis showed that after disease severity, the degree of time spent in homelessness had the most significant effect on mortality, with a HR of 1.47 associated with both HLI 2 and 3 (95% CI: 1.08–2.00 and 1.01–2.14, respectively). We find that in Hungary, homelessness is associated with a much higher lung cancer burden linked to a three-times-higher prevalence, lower overall survival and almost 50% lower annualized disease-specific healthcare costs. Worse outcomes are mainly driven by long-term homelessness. Results could not be further refined according to lifestyle-related factors due to data availability limitations.
无家可归者（PEH）在生活方式和医疗服务寻求行为方面的差异已广为人知。然而，由此产生的医疗资源利用差异及健康结果影响迄今尚未得到充分研究，尤其是在国家层面。本研究旨在填补匈牙利全民医疗体系中肺癌相关证据的空白。我们分析了2015年至2021年间匈牙利国家中央健康保险登记数据集中无家可归人群及匹配对照人群的肺癌相关信息。在此期间，共有11,857人在至少一年内被登记为无家可归者。为量化无家可归状态的影响，我们根据个体在调查期间处于无家可归状态的时间比例，创建了分类"无家可归时长指数"（HLI）（HLI 0：0；HLI 1：>0–1/3；HLI 2：>1/3–2/3；HLI 3：>2/3）。按年龄、性别和地区进行1:5匹配后，获得非无家可归者对照样本。我们采用Kaplan-Meier生存分析和经年龄、性别、HLI及肺癌相关平均医疗费用调整的Cox比例风险回归模型。最终分析样本包含观察期间新确诊的641例肺癌患者（233例无家可归者，408例对照）。无家可归组的肺癌患病率为1.97%，而对照组为0.69%。Kaplan-Meier曲线显示无家可归组的平均生存时间低于对照组。从确诊到死亡/删失期间的肺癌相关费用存在显著差异，无家可归组患者人均累计费用为3668欧元，对照组为6827欧元（2018年价格），相当于无家可归患者年均肺癌相关医疗费用降低47%。Cox回归分析表明，在疾病严重程度之后，无家可归时长对死亡率的影响最为显著，HLI 2和3的风险比均为1.47（95% CI分别为1.08–2.00和1.01–2.14）。研究发现，在匈牙利，无家可归状态与更高的肺癌负担相关，表现为患病率增加两倍、总生存期缩短以及年均疾病专项医疗费用降低近50%。不良结局主要与长期无家可归状态相关。受数据可及性限制，未能根据生活方式相关因素进行进一步细化分析。
肿瘤(癌症)患者之家