Disparities in place of death (PoD) in patients with gastrointestinal (GI) cancers.

Abstract

645 Background: PoD is an important determinant of patient and caregiver experience. Differences in PoD may reflect disparities in care, including aggressive end-of-life (EOL) care, and access to palliative care/hospice services and caregiver support/resources. We sought to describe sociodemographic disparities in PoD in patients dying from GI cancers between 2003-2019. Methods: We used deidentified death certificate data via the CDC Wonder database. We included decedents with an underlying cause of death of GI cancer (identified through ICD codes) from 2003-2019. We stratified findings by ethnicity, race, gender, and age (< or ≥ 65 years). We classified PoD as (1) medical facility (2) nursing home, (3) home, or (4) hospice facility. We estimated Annual Percentage Change (APC) in PoD across sociodemographic groups. Results: We included 2,347,754 decedents in the analysis (43.6% women, 68.4% ≥65 years, 7.6% Hispanic, 12.7% non-Hispanic Black [NHB], 75.4% non-Hispanic White [NHW]). From 2003– 2019, across all groups, deaths in medical facility reduced from 45,046 (33.4% of all deaths in the year) to 38,673 (23.3%) (APC -2.2%), and deaths in hospice increased from 871 (0.6%) to 24,092 (14.8%) (APC 26.1%). In 2019, men more frequently died in a medical facility than women (25.5% vs. 21.1% of deaths), and women were more likely to die in a nursing home facility than men (12.6% vs. 9.8%). In 2019, individuals aged<65 years died in a medical facility more frequently than those aged ≥65 years (29.8% vs. 21.0%), and also had lower APC for medical facility deaths from 2003– 2019 (APC -1.8% vs. -2.4%). Among groups, NHWs were least likely to die in a medical facility in (21.0% of deaths in 2019) and most likely to die in a hospice facility (15.5% of deaths in 2019). Hispanic individuals (vs. non-Hispanic individuals) had higher rates of home deaths, and lower hospice and nursing home deaths. Conclusions: Despite overall reductions in deaths in medical facilities for people with GI cancers over time, there remain significant sociodemographic disparities. Targeted interventions for care access, economic stability, and social communities are needed to address these findings. PoD for patients with GI cancer.[Table: see text]