Changes in the Place of Death in the United States

To the Editor: Where people die is an impor tant determinant of patient and caregiver expe rience.To assess changes in place of death, we analyzed data from the Centers for Disease Control and Prevention and the National Center for Health Statistics database for natural deaths in the United States from 2003 through 2017.Cause of death was defined as the medical con dition that had started the events that led direct ly to death, as recorded by the physician on the death certificate. 1 Deaths from external causes were excluded.Between 2003 and 2017, there were nearly 35.2 million natural deaths (Fig. 1).Most were attributed to cardiovascular disease (29.3%), followed by cancer (24.5%), respiratory disease (10.5%), dementia (7.9%), and stroke (5.9%).In 2003, a total of 905,874 deaths occurred in hospitals (39.7%), which decreased to 764,424 (29.8%) in 2017, whereas the number of deaths at nursing facilities decreased from 538,817 (23.6%) to 534,714 (20.8%).The number of deaths at home increased from 543,874 (23.8%) in 2003 to 788,757 (30.7%) in 2017, whereas the number of deaths at hospice facilities increased from 5395 (0.2%) to 212,652 (8.3%).These trends were seen across all disease groups.Younger patients, female patients, and racial and ethnic minorities had lower odds of death at home than did older patients, male patients, and white patients.Patients with cancer had the greatest odds of death at home and death at a hospice facility and the lowest odds of death at a nursing facility relative to other conditions.Patients with dementia had the greatest odds of death at a nursing facility, and patients with re spiratory disease had the greatest odds of death at a hospital.Patients with stroke had the lowest odds of death at home, and patients with cardio