Place of Death Among Early-Onset Colorectal Cancer Decedents in the United States, 1999-2020: National Trends and Disparities.

内容摘要

Place of death is a key population-level indicator of where end-of-life care occurs. We examined place-of-death trends and sociodemographic disparities among U.S. early-onset colorectal cancer (EOCRC) decedents. Using CDC WONDER mortality data (1999-2020) for colorectal cancer decedents aged&#x2009;<&#x2009;50 years, we analyzed the primary outcome of death at home/hospice facility vs. other settings. Trends were assessed with log-linked Poisson regression (annual percent change [APC]); subgroup associations were examined using multivariable logistic regression. Of 75,428 EOCRC decedents, 54.1% died at home/hospice facilities. This proportion increased from 48.3% (1999) to 66.6% (2020) (APC: 1.87%, 95% CI: 1.72-2.03%). In adjusted analyses, Black (aOR: 0.56, 95% CI: 0.54-0.59) and Asian or Pacific Islander (aOR: 0.71, 95% CI: 0.66-0.77) decedents had lower odds of home/hospice death than White decedents. Decedents in the Northeast also had lower odds than those in the South (aOR: 0.74, 95% CI: 0.71-0.77). Separate analyses of home vs. hospice deaths from 2003 to 2020 indicated a sharp increase in hospice facility deaths, whereas the home death trend was sensitive to the inclusion of 2020. Non-acute-institutional deaths became more common among EOCRC decedents from 1999 to 2020, but significant racial and regional disparities persisted. These findings highlight the need to evaluate barriers to hospice access and community-based end-of-life care in this younger population.