Trends and demographic disparities in the preferred place of death for bladder cancer patients in the United States (2000–2020): An analysis from the CDC database.

Abstract

747 Background: Understanding trends in end-of-life care for bladder cancer patients, particularly their preferred place of death (PPOD), is essential for improving palliative care planning. Despite being a leading cause of mortality in the U.S., there is limited insight into how preferences for end-of-life settings have evolved over time, or how they vary across demographic groups. Identifying these trends can help enhance care quality and address disparities in access to hospice and home-based care. This study aims to provide a comprehensive analysis of PPOD trends for bladder cancer patients from 2000 to 2020. Methods: Data from the CDC WONDER database were used to analyze bladder cancer mortality trends between 2000 and 2020. Deaths were categorized by place of death (home, hospice, medical facility, nursing home), age, race, census region, and year. Descriptive statistics summarized mortality trends, and chi-square tests assessed associations between demographic characteristics and place of death. Logistic regression identified factors associated with hospice utilization, adjusting for age, race, and region. The analysis also examined the impact of the COVID-19 pandemic on end-of-life care in 2020. Results: Between 2000 and 2020, there were 293,906 bladder cancer deaths in the U.S., with the South accounting for the highest proportion (35.6%). Home was the most common place of death (41.6%), followed by medical facilities (24.4%), nursing homes (19.5%), and hospice facilities (9.0%). Significant associations were found between place of death and age, race, and region (p < 0.001). Logistic regression showed younger individuals (under 85) had higher odds of dying in hospice, while Black individuals were less likely to use hospice than White individuals (OR = 0.699, p < 0.001). Hospice utilization increased over time (OR = 1.134 per year, p < 0.001). In 2020, home and hospice deaths increased, with a decline in medical facility deaths, likely due to the COVID-19 pandemic. Conclusions: Hospice care and home-based end-of-life care have become more prominent, though disparities in access persist, particularly among racial and regional groups. These findings highlight the need for more inclusive palliative care strategies to ensure equitable access to compassionate end-of-life care for all patients. Logistic regression results for factors influencing hospice utilization. Variable B S.E. p-value Odds Ratio 35-44 years -18.100 1742.864 0.992 0.000 45-54 years 0.309 0.041 <0.001 1.362 55-64 years 0.291 0.023 <0.001 1.338 65-74 years 0.207 0.018 <0.001 1.230 75-84 years 0.121 0.017 <0.001 1.128 Asian or Pacific Islander -19.165 946.130 0.984 0.000 Black or African American -0.358 0.031 <0.001 0.699 Year (2000-2020) 0.126 0.001 <0.001 1.134