Trends in location of death among adolescents and young adults with solid and liquid tumors in the United States.

Abstract

e13755 Background: The location of death is a vital aspect of end-of-life (EOL) care for adolescent and young adult (AYA) cancer patients, influenced by clinical, demographic, and systemic factors. This study investigated differences in location of death among patients with solid tumors (brain, breast, colorectal) and liquid tumors (leukemia) and evaluated how age, sex, race, and ethnicity influenced these patterns. Methods: Data for 173,220 cancer decedents aged 15–39 years were analyzed from the CDC WONDER database (2003–2020). Solid tumors were identified by ICD-10 codes C71, C50, C18.0–C20, C78.5, and leukemia by C91–C95. Multinomial logistic regressions assessed associations between decedent characteristics and location of death. Results: Of the decedents, 78,964 died in hospitals, 60,085 at home, 5,762 in nursing facilities, 13,510 in hospice facilities, and 14,899 in outpatient facilities/ED. Younger patients were more likely to die in hospice facilities, with those aged 25–29 being over twice as likely compared to those aged 15–19 (2.12, 95% CI 2.00–2.23), while older patients (aged 35-39) were nearly five times as likely to die in nursing facilities (4.97, 95% CI 4.17–5.93). Male patients were slightly more likely to die in hospitals (1.07, 95% CI 1.05–1.09) and less likely to die in hospice facilities (0.94, 95% CI 0.90–0.98). Racial and ethnic disparities were consistent across tumor types. Black patients were more likely to die in hospitals than White patients (solid tumors: 59% higher; leukemia: 34% higher). Hispanic and Asian patients with solid tumors were 30% and 70% more likely, respectively, to die in hospitals. Black and Asian patients were also consistently less likely to die at home; Black patients with solid tumors were 45% less likely, and Asian patients with leukemia were 47% less likely. Patients with leukemia were more likely to die in nursing facilities compared to solid tumor patients, particularly among older age groups. Among those aged 35–39, leukemia patients were nearly four times as likely to die in nursing facilities (8.67, 95% CI 3.72–20.21 vs. 2.26, 95% CI 0.83–6.12). Younger patients with leukemia were also more likely to die in hospice, with those aged 25–30 being over four times as likely compared to patients with solid tumors (4.48, 95% CI 3.03–6.60 vs. 1.73, 95% CI 1.01–2.97). Conclusions: Significant demographic and tumor-specific disparities in location of death exist among AYA patients with cancer. Younger age was associated with hospice deaths, while older age correlated with nursing facility deaths. Racial and ethnic minorities had higher hospital deaths and lower home deaths across tumor types. These findings underscore the need for tailored EOL care strategies to ensure access to preferred care settings.