Sociodemographic Determinants of End-of-Life Care Settings and Place of Death among Patients with Lung Cancer in the United States

Document Type

Conference Proceeding

Publication Date

5-27-2026

Publication Title

J Clin Oncol

Keywords

adult, aged, at home mortality, cadaver, cancer mortality, Caucasian, conference abstract, controlled study, death certificate, emergency care, ethnicity, female, hospice, hospice care, hospice nursing, human, lung cancer, major clinical study, male, metropolitan area, outpatient, place of death, retrospective study, rural area, terminal care, United States, urbanization, very elderly

Abstract

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.

Volume

44

Issue

16_Suppl

First Page

12077

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