National trends in location of death in patients with end-stage liver disease

Article

KAPLAN, Alyson | FORTUNE, Brett | UFERE, Nneka | BROWN, Robert S. | ROSENBLATT, Russell

Despite improvement in the care of patients with end-stage liver disease (ESLD), mortality is rising. In the United States, patients are increasingly choosing to die at hospice and home, but data in patients with ESLD are lacking. Therefore, this study aimed to describe trends in location of death in patients with ESLD. We conducted a retrospective cross-sectional analysis using the Centers for Disease Control and Prevention Wide-ranging OnLine Data for Epidemiologic Research from 2003-2018. Death location was categorized as hospice, home, inpatient, nursing home, or other. Comparisons were made between gender, age, ethnicity, race, region, and with other causes of death. Comparisons were also made between rates of change (calculated as annual percent change), proportion of deaths in 2018, and with multivariable logistic regression. 535,261 deaths were attributed to ESLD - most were male, non-Hispanic, and White. The proportion of deaths at hospice and home increased over the study period from 0.2% to 10.6% and 20.3% to 25.7%, respectively. Whites had the highest proportion of deaths in hospice and home. In multivariable analysis, elderly patients were more likely to die in hospice or home (OR 1.20 CI 1.07-1.35), while black patients were less likely (OR 0.58 CI 0.46-0.73). Compared to other causes of death, ESLD had the second highest proportion of deaths in hospice but lagged behind non-hepatocellular carcinoma malignancy. CONCLUSION: Deaths in patients with ESLD are increasingly common at hospice and home overall, and while the rates have been increasing among black patients, they are still less likely to die at hospice or home. Efforts to improve this disparity, promote end-of-life care planning, and enhance access to death at hospice and home are needed.

http://dx.doi.org/10.1002/lt.25952

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