Changes in Place of Death in the United States (CS202A)

Abstract

•Summarize temporal trends in place of death for individuals in the US.•Understand demographic and disease factors associated with place of death. Place of death is an important aspect of the patient/caregiver experience and knowing where patients die is essential for delivery of high-quality end-of-life care. To assess trends and factors associated with location of death among decedents from natural causes in the United States (US). We analyzed mortality data for all deaths in the US from 2003 to 2017. We used multivariable logistic regression to evaluate associations between demographic characteristics and place of death for years 2013-2017. Between 2003 and 2017, there were nearly 35.2 million natural deaths. In 2003, 905,874 deaths occurred in hospitals (39.7%), decreasing to 764,424 (29.8%) in 2017, while nursing facility deaths reduced from 538,817 (23.6%) to 534,714 (20.8%). Home deaths increased from 543,874 (23.8%) in 2003 to 788,757 (30.7%) in 2017, while hospice facility deaths increased from 5,395 (0.2%) to 212,652 (8.3%) by 2017. Younger patients, females, and racial/ethnic minorities had reduced odds of home death compared to older patients, males, and whites. Cancer patients had the greatest odds of home and hospice facility deaths and the lowest odds of nursing facility death, relative to other conditions. Dementia patients had the greatest odds of nursing facility death, and respiratory disease patients had the greatest odds of hospital death, relative to other conditions. Stroke patients had the lowest odds of home death, and cardiovascular disease patients had the lowest odds of hospice facility death, relative to other conditions. Home has surpassed hospital as the most common place of death in the US. Disparities in place of death exist by demographics and underlying cause of death.