Our Research

Before medically advised (BMA) discharge, which refers to patients leaving the hospital at their own discretion, is associated with higher rates of readmission and death in other settings. There is limited information on whether housing status is associated with BMA after surgery. This study used multivariable logistic regression to evaluate the association between housing status and BMA discharge. Researchers found that BMA discharge is more common in patients experiencing homelessness after surgery.

Loneliness is often more common in older adults and those who face structural vulnerabilities, including those who experience homelessness. In the United States, 48% of single homeless adults are 50 and older. There is a limited information about loneliness among older adults who have experienced homelessness. This study used qualitative data collected as part of a longitudinal mixed-methods study, Health Outcomes of People Experiencing Homelessness in Older Middle Age (HOPE HOME). The study aimed to examine the intersection between social isolation, functional and cognitive impairment, and use of supportive services among a cohort of older adults experiencing homelessness in Oakland, California. Researchers found that homeless-experienced older adults with cognitive or functional impairments exhibited diverse loneliness experiences.

On a single night in 2023, more than 653,000 people experienced homelessness in the United States. In this overview, researchers highlight the structural and individual risk factors that lead to homelessness, explore evidence on the relationship between homelessness and health, discuss programmatic and policy innovations, and provide policy recommendations.

Cancer is a leading cause of death in older unhoused adults. In this retrospective cohort study, researchers assessed whether being unhoused, gaining housing, or losing housing in the year after cancer diagnosis is associated with poorer survival compared with being continuously housed. Researchers used a national sample of veterans with lung, colorectal, and breast cancer during the period of 2011-2020. Findings showed veterans who were unhoused before and for the twelve months after their diagnosis had 10–20 percent greater risk for all-cause mortality than veterans who were consistently housed, even after adjustment for multiple factors.

Responses to the overdose crisis in North America are increasingly centered on harm reduction approaches. In this commentary researchers aim to highlight current housing-based overdose prevention interventions and to situate them within the broader environmental contexts of marginal housing. Housing interventions need to be expanded, but also attend to the contextual drivers of risks in these settings to best foster enabling environments for harm reduction and maximize impacts.

Unhoused patients have worse surgical outcomes than the general population, resulting in premature mortality. Researchers conducted 26 semi-structured interviews of clinicians who care for patients with surgical disease. The researchers identified 5 themes, including, but not limited to: patients and clinicians face multiple challenges meeting preoperative requirements; although surgeons do not make major operative decisions based on housing status, some take it into consideration for minor care decisions; clinicians perceive that unhoused patients have negative postoperative experiences in the hospital.

Cancer is a leading cause of death among older people experiencing homelessness. In this retrospective cohort study, researchers sought to characterize the diagnosis, treatment, surgical outcomes, and mortality by housing status of patients who receive care from the US Department of Veterans Affairs (VA) health system for colorectal, breast, or lung cancer. Researchers found that homelessness was associated with later stages at diagnosis for colorectal cancer.

In this commentary of the study "Housing Status, Cancer Care, and Associated Outcomes Among US Veterans", Maria C. Raven, MD, MPH, associate Professor and Chief of Emergency Medicine at UCSF, provides lessons from the Veterans Health Administration. In 2009, the VHA began a multipronged initiative designed to end and prevent homelessness among veterans, which led to a 45% reduction in veteran homelessness from 2009 to 2017. Dr. Raven writes, "The results of this study indicate that in addition to providing housing at comparatively high rates for unhoused veterans, the system’s initiative to prevent and end veteran homelessness has also likely helped reduce important disparities in oncologic care for this population."

Cancer is the leading cause of mortality for people experiencing homelessness (PEH). However, not much is known about cancer-related surgical outcomes among PEH. This retrospective cohort study aimed to characterize access to care among PEH, evaluate postoperative outcomes, and assess costs associated with surgery for malignancy among PEH. Researchers found that PEH were less likely to undergo surgery for malignancy at cancer centers than hose who are housed. People experiencing homelessness also had a higher risk of requiring unplanned surgery.