Trends in location of death for individuals with primary brain tumors in the United States.

Abstract

Primary brain tumors are associated with severe cognitive effects on quality of life and poor overall survival. End-of-life experiences for these patients are critical1,2; the majority of patients wish to die at home or in a hospice facility, whereas death in hospital settings or nursing homes may be associated with lower rates of adequate symptom management and emotional support.3 Previous literature has revealed racial and sociodemographic disparities in location of death for cancer patients.2 Therefore, we assessed trends in location of death among patients with malignant brain tumors to provide insight into these sociodemographic disparities for the neuro-oncology population. Using the publicly available CDC WONDER database, we assessed associations between decedent characteristics and location of death for patients with primary malignant neoplasm of the brain (ICD10 codes C71.0-C71.9) through multivariable logistic regression, reporting adjusted odds ratios (ORs) with 95% confidence intervals (CI). We evaluated the significance of trends in location of death over time with linear regression models adjusting for time alone and the interaction between time and race. Additionally, we conducted subgroup analyses to verify our results across multiple brain anatomical regions. Locations of death included hospital, home, nursing facility, hospice facility, and outpatient medical facility/emergency department (ED). Decedent characteristics included age, sex, race, ethnicity, marital status, and education.