But minorities might not be gaining as much, study suggests
The end-of-life experience for U.S. stroke patients is changing, according to a study that found fewer dying in hospitals in recent years.
Trends in location of death observed from 2003 to 2017 in a CDC database listing more than 2 million deaths attributed to cerebrovascular disease in the U.S. included fewer patients dying in hospital (from 46.% to 36.5%) or at nursing facilities (from 35.0% to 25.4%).
Over the same period, home deaths increased from 10.8% to 18.9% and more died at hospice facilities as well (up from 0.2% to 11.9%), according to Haider Warraich, MD, of Duke University Medical Center in Durham, North Carolina, and colleagues reporting online in JAMA Neurology.
Dead on arrival and the approximately 8% of deaths categorized as "other," such as deaths at a outpatient medical facility or an emergency department, stayed fairly constant during this period.
"While the majority of patients [who] had a stroke die in the hospital, our data suggest that the proportion of patients who had a stroke die at home, a location preferred by patients, has increased substantially. However, the experience of patients who had a stroke dying at home, and that of their caregivers, remains underinvestigated," the investigators said.
It's "encouraging" to see the trends of increasing home and hospice death, commented Shyam Prabhakaran, MD, MS, of The University of Chicago. "It indicates that practitioners are trying to ensure wishes of families and patients are fulfilled."
Warraich's team noted certain disparities in location of death according to demographic group.
For one, non-white and Hispanic stroke patients had lower odds of dying in a nursing facility or hospice; they were more likely to die at home or at the hospital.
"Lower use of palliative care and hospice services has been reported among minorities for other conditions and our analysis demonstrates consistency of this trend in stroke patients. Further research is needed to elucidate if racial and ethnic disparities in location of death represent a lack of access to home supports or hospice services or if they reflect differences in culture and care preferences," Warraich's group said.
In addition, individuals ages 85 years and older were less likely to die in the hospital and more likely to do so in a nursing facility, at home, or at a hospice.
Men had higher odds of dying at the hospital than at home, compared with women. Married people were more likely to die in a hospital or at home and less likely to do so in a nursing facility, the researchers found.
"The study's primary limitations were reliance on death certificates alone for ascertaining location of death and inability to know whether hospice services were delivered for patients dying at home or in nursing facilities," the researchers noted.
Last Updated August 19, 2019
Warraich reported no conflicts of interest.
Source Reference: Cross SH, et al "Trends in location of death for individuals with cerebrovascular disease in the United States" JAMA Neurol 2019; DOI: 10.1001/jamaneurol.2019.2566.
Read the original article on Medpage Today: Stroke Deaths Increasingly Come at Home, Hospice