Patterns in place of death amongst Black women with breast cancer: A retrospective study.

Abstract

e13741 Background: Breast cancer remains a leading cause of cancer-related mortality amongst Black women, who experience disproportionately higher mortality rates compared to other racial groups. Structural inequities, delayed diagnoses, differences in treatment access, and socioeconomic barriers contribute to these disparities. Despite the high burden of breast cancer in the Black community, limited research has examined end-of-life outcomes, particularly the patterns in the place of death. Understanding where Black women with breast cancer die can provide insight into healthcare access, utilization of palliative services, and regional disparities in care. This study investigates trends in the place of death amongst Black women with breast cancer in the United States from 1999-2020. Methods: A retrospective analysis was conducted using data from the CDC WONDER database, examining death certificates listing breast-cancer-related deaths (ICD-10 codes C50.0-C50.9) in Black women from 1999-2020. Demographic factors including year, age, and urbanization status were examined with respect to the place of death. The number and percentage of deaths occurring in various locations were tracked to identify patterns and trends. Results: 151,734 deaths were attributed to breast cancer in Black women from 1999 to 2020. The majority occurred in inpatient settings (39.5%), followed by deaths at home (30.9%). Temporally, home deaths in 2020 approached a two-fold increase compared to 1999. In addition, deaths in nursing homes/long-term care facilities rose progressively with advancing patient age, peaking in women aged 85 years and above. Comparing across urbanization statuses, Black women in urban settings were nearly twice as likely to die in hospice compared to women in rural settings (7.7% vs 4%). Regionally, the South and Midwest census regions recorded the highest burdens. Conclusions: Distinct and evolving patterns in place of death are observed among Black women with breast cancer, with significant variation by age, time period, and urbanization status. The increasing shift toward home deaths over time suggests gradual improvement in end-of-life care utilization; however, the persistently high proportion of inpatient deaths and the rising burden of nursing facility deaths among older women underscore ongoing gaps in timely palliative care integration. Marked rural–urban disparities in hospice deaths further highlight structural inequities in access to end-of-life services. Targeted efforts to expand equitable hospice availability, promote earlier palliative care referral, and address geographic barriers are essential to improving patient-centered end-of-life care for Black women with breast cancer.