Trends in Place of Death for Individuals With Deaths Attributed to Advanced Chronic or End-Stage Kidney Disease in the United States |
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| Authors: | Sarah H. Cross Joshua R. Lakin Mallika Mendu Ernest I. Mandel Haider J. Warraich |
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| Affiliation: | 1. Sanford School of Public Policy, Duke University, Durham, North Carolina, USA;2. Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA;3. Division of Palliative Medicine, Brigham and Women''s Hospital, Boston, Massachusetts, USA;4. Harvard Medical School, Boston, Massachusetts, USA;5. Renal Division, Department of Medicine, Brigham and Women''s Hospital, Boston, Massachusetts, USA;6. Department of Quality and Safety, Brigham and Women''s Hospital, Boston, Massachusetts, USA;7. Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women''s Hospital, Harvard Medical School, Boston, Massachusetts, USA;8. Cardiology Section, Department of Medicine, Boston VA Healthcare System, Boston, Massachusetts, USA;1. Division of Population Sciences, Dana-Farber/Partners CancerCare, Boston, Massachusetts, USA;2. Division of Gastrointestinal Oncology, Dana-Farber/Partners CancerCare, Boston, Massachusetts, USA;3. Susan F. Smith Center for Women''s Cancers, Dana-Farber/Partners CancerCare, Boston, Massachusetts, USA;4. Division of Medical Oncology, University of North Carolina Lineberger Cancer Center, Chapel Hill, North Carolina, USA;5. Division of Hematology and Oncology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA;6. Division of Medical Oncology, Virginia Commonwealth University, Richmond, Virginia, USA;7. Division of Medical Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA;8. Department of Nursing, Dana-Farber/Partners CancerCare, Boston, Massachusetts, USA;1. ICES, Toronto, Ontario, Canada;2. Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada;3. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada;4. Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada;1. St Jude Children''s Research Hospital, Memphis, Tennessee, USA;2. Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland, USA;3. Johns Hopkins School of Medicine, Baltimore, Maryland, USA;4. National Institutes of Health, Bethesda, Maryland, USA;1. Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA;2. Psychology Department, Fordham University, New York, New York, USA;1. Saint Thomas West Hospital, Nashville, Tennessee, USA;2. The George Washington University Hospital, Washington, District of Columbia, USA;3. Department of Medicine (Palliative Care), Northwestern Feinberg School of Medicine, Chicago, Illinois, USA |
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| Abstract: | ContextAn important aspect of end-of-life care, place of death is understudied in advanced chronic (CKD) and end-stage kidney disease (ESKD).ObjectiveWe sought to examine trends and factors associated with where advanced CKD/ESKD patients die.MethodsWe conducted a retrospective cross-sectional study using mortality data from 2003 to 2017 for deaths attributed primarily to advanced CKD/ESKD in the United States.ResultsBetween 2003 and 2017, 222,247 deaths were attributed to advanced CKD/ESKD. From 2003 to 2017, deaths occurring in hospitals declined from 56.0% (n = 5356) to 35.6% (n = 7764), whereas increases occurred in deaths at home (13.5% [n = 1292] to 24.3% [n = 5306]), nursing facilities (18.6% [n = 1776] to 19.3% [n = 4221]), and hospice facilities (0.3% [n = 29] to 13.4% [n = 2917]). Nonwhite race was associated with increased odds of hospital death (Black [OR = 1.59; 95% CI = 1.55, 1.62]; Native American [OR = 1.47; 95% CI = 1.32, 1.63]; Asian [OR = 1.43; 95% CI = 1.32, 1.55] and reduced odds of nursing facility (Black [OR = 0.622; 95% CI = 0.600, 0.645]; Native American [OR = 0.638; 95% CI = 0.572, 0.712]; Asian [OR = 0.574; 95% CI = 0.533, 0.619], or hospice facility death (Black [OR = 0.843; 95% CI = 0.773, 0.918]; Native American [OR = 0.380; 95% CI = 0.289, 0.500]; Asian [OR = 0.609; 95% CI = 0.502, 0.739]). Older age was associated with reduced odds of hospital death (≥85 [OR = 0.334; 95% CI = 0.312, 0.358]) and increased odds of home (≥85 [OR = 1.55; 95% CI = 1.43, 1.68]), nursing facility (≥85 [OR = 3.09; 95% CI = 2.76, 3.45]) or hospice facility death (≥85 [OR = 1.60; 95% CI = 1.49, 1.72]).ConclusionsHospitals remain the most common place of death from advanced CKD/ESKD; however, the proportion of home, nursing facility, and hospice facility deaths have increased. |
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| Keywords: | Palliative care hospice kidney disease renal disease disparities place of death |
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