Abstract 61: Major Adverse Cardiovascular And Cerebrovascular Events Among Homeless Cancer Survivors: A Decade-apart Nationwide Hospitalizations Analysis

Background: Homelessness being one of the independent risks for cardiovascular disease (CVD), we explored the burden of CVD risk factors and major adverse cardiac and cerebrovascular events (MACCE) and in-hospital outcomes among homeless cancer survivors in the USA two-decade apart.

Methods: We compared the baseline demographic, comorbidities, and inpatient MACCE outcomes (all-cause mortality, cardiac arrest including arrhythmia, and stroke) between 2007 and 2017 using homeless cancer survivors’ hospitalizations from National Inpatient Sample datasets.

Results: A total of 14973 (median age 59 years, 53.4% male) admissions among homeless cancer survivors were studied (4778 in 2007 & 10195 in 2017, Table 1). Cohort 2017 had younger (median age 57 vs. 71 years), male (59.5% vs. 40.5%), Hispanic (8.0% vs. 5%), non-elective (93.8% vs. 87.4%) and low household income (24.7% vs. 20.8%) (p<0.001) admissions, and had a significantly higher burden of traditional cardiovascular risk factors like smoking, hypertension, hyperlipidemia, diabetes with chronic complications, congestive cardiac failure, alcohol abuse, drug abuse and depression compared to 2007 cohort. Univariate incidence of composite MACCE (16.2 vs 19.5%) and all-cause mortality (0.9 vs 1.3%) were significantly lower in 2017 compared to 2007. Multivariate analysis after socio-demographics, admitting hospital-related characteristics and comorbidities did not reveal worsening for MACCE-related hospitalizations (aOR 1.16, 95 CI 0.83-1.62, p=0.381).

Conclusion: Homeless cancer survivors tend to be younger in 2017 than in 2007, with higher prevalence of cardiovascular risk factors and hospitalizations related to MACCE. However, they also tend to have improved in-hospital outcomes. Propagating aggressive screening in such survivors may further prevent MACCE-related hospitalizations.