Abstract 4369738: Where Cardiac Arrest Claims: A Mapping of End-of-Life Care by Demographics and Region, 1999–2024

Abstract

Introduction/Background: Cardiac arrest caused >9M U.S. adult deaths (1999–2024). Place of death reflects end-of-life care quality. While home/hospice deaths rose for other conditions, cardiac arrest patterns by demographics remain understudied. Research Questions/Hypothesis: Death location varies by demographics, with younger/minority patients more likely to die in EDs and less likely in hospice than older White patients. Methods/Approach: From CDC WONDER, we extracted all U.S. adult (≥25 y) deaths attributed to cardiac arrest (ICD-10 I46) from 1999–2021. Place of death was categorized as inpatient (ref), ED/outpatient, home, hospice/nursing, or other. Crude ORs (95% CIs) comparing each non-inpatient location to inpatient were computed via 2×2 tables, stratified by age (25–44, 45–64, 65–84 [ref], ≥85), sex (male [ref], female), race (White [ref], Black, AI/PI), Hispanic origin (non-Hispanic [ref], Hispanic), and urbanization (large metro [ref], medium/small metro, rural Results/Data: Overall, 41.2% died in hospital; 11.1% in outpatient/ED; 22.5% at home; 20.5% in hospice/nursing; 4.6% elsewhere. Compared with 65–84, 25–44 showed lower home (OR 0.58; 95% CI 0.57–0.58; P<0.001) and hospice (OR 0.20; 95% CI 0.18–0.22; P<0.001), but higher ED (OR 1.08; 95% CI 1.07–1.09; P<0.001). Conversely, ≥85 had higher home (OR 1.39; 95% CI 1.38–1.39; P<0.001) and hospice (OR 2.96; 95% CI 2.95–2.97; P<0.001), but lower ED (OR 0.82; 95% CI 0.81–0.82; P<0.001). Females had higher home (OR 1.02; 95% CI 1.02–1.03; P<0.001) and hospice (OR 1.74; 95% CI 1.73–1.74; P<0.001), but lower ED (OR 0.79; 95% CI 0.79–0.80; P<0.001). Blacks had lower home (OR 0.61; 95% CI 0.61–0.62; P<0.001) and hospice (OR 0.55; 95% CI 0.55–0.55; P<0.001), but higher ED (OR 1.13; 95% CI 1.12–1.14; P<0.001) versus Whites. Hispanics had lower home (OR 0.82; 95% CI 0.82–0.83; P<0.001), ED (OR 0.69; 95% CI 0.69–0.70; P<0.001), and hospice (OR 0.56; 95% CI 0.56–0.56; P<0.001) than non-Hispanics. Rural decedents had higher home (OR 1.26; 95% CI 1.25–1.26; P<0.001), ED (OR 1.59; 95% CI 1.58–1.60; P<0.001), and hospice (OR 1.09; 95% CI 1.09–1.10; P<0.001) versus large-metro. Conclusion(s): Only 41% died in hospital. Young adults had higher ED deaths; ≥ 85 and women had more home/hospice deaths. Blacks, Hispanics, and rural groups faced lower home/hospice and higher ED mortality, warranting equitable palliative care interventions.