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. 2020 Aug;158(2):670-680.
doi: 10.1016/j.chest.2020.02.062. Epub 2020 Mar 27.

Place of Death for Individuals With Chronic Lung Disease: Trends and Associated Factors From 2003 to 2017 in the United States

Sarah H Cross  1 , E Wesley Ely  2 , Dio Kavalieratos  3 , James A Tulsky  4 , Haider J Warraich  5
Affiliations

Place of Death for Individuals With Chronic Lung Disease: Trends and Associated Factors From 2003 to 2017 in the United States

Sarah H Cross et al. Chest. 2020 Aug.

Abstract

Background: Although chronic lung disease is a common cause of mortality, little is known about where individuals with chronic lung disease die.

Research question: The aim of this study was to determine the trends and factors associated with place of death among individuals with chronic lung disease.

Study design and methods: This cross-sectional analysis of natural deaths was conducted by using the Centers for Disease Control and Prevention Wide-ranging OnLine Data for Epidemiologic Research from 2003 to 2017 for which COPD, interstitial lung disease (ILD), or cystic fibrosis (CF) was the underlying cause. Place of death was categorized as hospital, home, nursing facility, hospice facility, and other.

Results: From 2003 to 2017, more than 2.2. million deaths were primarily attributed to chronic lung disease (51.6% female, 92.4% white). Most were attributed to COPD (88.9%), followed by ILD (10.8.%), and CF (0.3%). Hospital and nursing facility deaths declined from 44.4% (n = 59,470) and 22.6% (n = 30,285) to 28.3% (n = 49,655) and 19.7% (n = 34,495), while home and hospice facility deaths increased from 23.3% (n = 31,296) and 0.1% (n = 192) to 34.7% (n = 60,851) and 9.0% (n = 15,861), respectively. Male sex, being married, and having some college education were associated with increased odds of home death, whereas non-white race and Hispanic ethnicity were associated with increased odds of hospital death. Compared with individuals with COPD, individuals with ILD and CF had increased odds of hospital death and reduced odds of home, nursing facility, or hospice facility death.

Interpretation: Home deaths are rising among decedents from chronic lung disease, increasing the need for quality end-of-life care in this setting. Further research should explore the end-of-life needs and preferences of these patients and their caregivers, with particular attention paid to patients with ILD and CF who continue to have high rates of hospital death.

Keywords: COPD; cystic fibrosis; home; interstitial lung disease; palliative care.

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Figures

Figure 1
Figure 1
Participation flowchart. CF = cystic fibrosis; ILD = interstitial lung disease.
Figure 2
Figure 2
Trends for lung disease in places of death (2003-2017).
Figure 3
Figure 3
Trends according to age in places of death (2003-2017).
Figure 4
Figure 4
Trends according to race and ethnicity in places of death (2003-2017).
Figure 5
Figure 5
Trends according to lung disease subtype in places of death (2003-2017). See Figure 1 legend for expansion of abbreviations.
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