12077 Background: Optimizing the place of death is a key component of quality end-of-life (EOL) cancer care, with home and hospice settings generally preferred over acute care hospitals. While lung cancer mortality has declined, disparities in EOL care utilization remain a concern. This study utilized the CDC WONDER database to analyze longitudinal trends and sociodemographic predictors of place of death for lung cancer decedents over a 25-year period. Methods: We performed a retrospective analysis of death certificate data for all lung cancer-related deaths in the U.S. from 1999 to 2023. Place of death was categorized as Decedent’s Home, Hospice/Nursing Facility, Medical Facility-Inpatient (referent), or Outpatient/ER. Multinomial logistic regression estimated adjusted odds ratios (aOR) with 95% confidence intervals (CI) for predictors, adjusting for age, sex, race, ethnicity, urbanization, and year. Results: A total of 3,563,902 lung cancer deaths were identified. The most common place of death was the decedent's home (44.9%), followed by inpatient medical facilities (30.7%) and hospice/nursing facilities (22.1%). There was a significant longitudinal shift away from inpatient death. For every advancing calendar year, the odds of dying at home increased by 3% (OR 1.03; 95% CI 1.03-1.03) and the odds of dying in a hospice/nursing facility increased by 4% (OR 1.04; 95% CI 1.04-1.04). Compared to White patients, Black patients had significantly lower odds of dying at home (OR 0.57; 95% CI 0.57-0.58) or in a hospice facility (OR 0.68; 95% CI 0.68-0.68). Notably, Black patients had 53% higher odds of dying in an Outpatient/ER setting (OR 1.53; 95% CI 1.53-1.53) compared to White patients. Patients in rural areas had higher odds of dying at home (OR 1.17; 95% CI 1.16-1.17) but lower odds of dying in a hospice/nursing facility (OR 0.93; 95% CI 0.92-0.93) compared to those in large metropolitan areas. Conclusions: From 1999 to 2023, lung cancer mortality shifted significantly from inpatient settings to home and hospice care. Yet, Black patients remain significantly less likely to utilize home/hospice care and more likely to die in acute ER settings. Additionally, rural patients show high home death rates but lower facility-based hospice use, suggesting infrastructure gaps. Targeted interventions are required to ensure equitable EOL care access.
Mushtaq et al. (Wed,) studied this question.