Trends in place of death among breast cancer patients in the United States (1999–2023): A 25-year analysis of racial and regional disparities.

Abstract

11152 Background: Breast cancer is the second most prevalent cancer among women in the United States, associated with significant morbidity and mortality related to treatment. The place of death (PoD) significantly influences patient and caregiver preferences, access to home-based supportive care, and the overall cost of caregiving. This study evaluates trends in PoD for patients with breast cancer in the U.S. from 1999 to 2023 using data from the CDC WONDER (Wide-ranging Online Data for Epidemiologic Research) database. Methods: We conducted a comprehensive analysis of data from the CDC WONDER database covering the period from January 1, 1999, to December 31, 2023. Deaths attributed to breast cancer were identified using the International Classification of Diseases-10th Revision (ICD-10) code C50. We collected demographic data to calculate descriptive statistics based on race, PoD, census region, and home and hospice utilization over the past 25 years. Results: Our analysis revealed a total of 1,047,098 breast cancer-related deaths from 1999 to 2023. Among these, 513,231 deaths (49.01%) occurred in home or hospice facilities (H&H), while 471,297 deaths (45.01%) were reported in medical facilities and nursing homes (M&N). The proportion of H&H deaths increased from 37.1% in 1999, peaked at 62.6% in 2020, and then declined to 56.9% in 2023. Racial disparities were evident, with all racial groups experiencing an increase in percentage of H&H mortality from 1999 to 2023. Black or African American individuals exhibited the highest relative percentage increase at 66.04%. In 2023, the highest rates of H&H mortality were observed in white patients (58.99%), followed by Hispanic patients (56.36%), American Indian or Alaska Native patients (50.51%), and Black or African American patients (48.90%). Regional analysis indicated that all regions saw an increase in H&H mortality from 1999 to 2023, with the Midwest showing the highest relative percent increase at 60.58%. In 2023, the South had the highest percentage of H&H mortality (59.80%), followed by the West (58.45%), Midwest (55.53%), and Northeast (49.33%). Conclusions: The trends in place of death for breast cancer patients over the past 25 years highlight significant shifts in mortality patterns, with increasing reliance on home and hospice care, particularly among certain racial and regional groups. These findings highlight the need for targeted interventions to improve access to palliative care services and support for patients and caregivers, particularly in underserved populations and regions.