Disparities in place of death in patients with lung cancer.

Abstract

12030 Background: Place of death (PoD) significantly impacts both patient and caregiver experiences at end-of-life in the United States (U.S.), with disparities often reflecting inequities in access to palliative care, hospice services, and caregiver resources. However, there is limited understanding of PoD and associated disparities in patients with lung cancer. This retrospective study examined sociodemographic differences in PoD among U.S. lung cancer decedents from 2003 to 2020. Methods: We analyzed de-identified death certificate data from the CDC Wonder database, focusing on lung cancer as the underlying cause of death (identified by ICD codes) from 2003 to 2020. The data were stratified by ethnicity, race, gender, and age (< 65 or ≥ 65 years). PoD was categorized into four groups: (1) medical facility, (2) nursing home, (3) home, and (4) hospice facility. The Annual Percentage Change (APC) in PoD across sociodemographic groups was calculated. Results: A total of 2,759,733 decedents were included (44.8% women, 72.4% age ≥ 65 years, 3.3% Hispanic, 10.5% Non-Hispanic Black (NHB), and 83.4% Non-Hispanic White (NHW)). Between 2003 and 2020, deaths in medical facilities declined from 37.2% (58,778) to 24.6% (33,416) (APC -2.55%), while hospice deaths increased from 0.5% (849) to 11.2% (15,290) (APC 25.37%). In 2020, men were more likely to die in a medical facility than women (26.4% vs 22.4%), and women were more likely to die in a nursing home (9.4% vs 8.4%). Younger patients (< 65) had higher rates of medical facility deaths than older patients (31.5% vs 22.4%), with a slower decline in medical facility deaths (APC -2.01% vs -2.75%). Hispanic individuals were more likely to die at home (52.5% in 2003 vs 51.0% in 2020) and less likely to utilize hospice (11.2% in 2020) or die in a nursing facility (8.9% in 2020). NHWs had the lowest rates of medical facility deaths (22.8% in 2020) and the highest rates of hospice deaths (11.6% in 2020). NHBs, despite an increase in hospice utilization (APC 26.73%, 2003-2020), remained more likely to die in medical facilities (33.6% in 2020). Conclusions: Over the past two decades, lung cancer PoD patterns have shifted, with reduced medical facility deaths and increased hospice utilization. However, significant disparities in end-of-life care persist across demographic groups, highlighting the need for targeted interventions to ensure equitable access to preferred care settings, including home-based and hospice services.