• Sarah H Cross, Brystana G Kaufman, Tammie E Quest, and Haider J Warraich.
• Sanford School of Public Policy, Duke University, Durham, North Carolina, USA. Electronic address: sarah.h.cross@duke.edu.
• J Pain Symptom Manage. 2021 Feb 1; 61 (2): 350-357.

ContextHospice facilities are increasingly preferred as a location of death, but little is known about the characteristics of patients who die in these facilities in the U.S.ObjectivesWe sought to examine the trends and factors associated with death in a hospice facility.MethodsRetrospective cross-sectional study using mortality data for years 2003-2017 for deaths attributed to natural causes in the U.S.ResultsThe proportion of natural deaths occurring in hospice facilities increased from 0.2% in 2003 to 8.3% in 2017, resulting in nearly 1.7 million deaths during this time frame. Females had increased odds of hospice facility deaths (odds ratio [OR] = 1.04; 95% CI = 1.04, 1.05). Nonwhite race was associated with lower odds of hospice facility death (black [OR = 0.915; 95% CI = 0.890, 0.940]; Native American [OR = 0.559; 95% CI = 0.515, 0.607]; and Asian [OR = 0.655; 95% CI = 0.601, 0.713]). Being married was associated with hospice facility death (OR = 1.06; 95% CI = 1.04, 1.07). Older age was associated with increased odds of hospice facility death (85 and older [OR = 1.40; 95% CI = 1.39, 1.41]). Having at least some college education was associated with increased odds of hospice facility death (OR = 1.13; 95% CI = 1.11, 1.15). Decedents from cardiovascular disease had the lowest odds of hospice facility death (OR = 0.278; 95% CI = 0.274, 0.282).ConclusionHospice facility deaths increased among all patient groups; however, striking differences exist by age, sex, race, marital status, education level, cause of death, and geography. Factors underlying these disparities should be examined.Copyright © 2020 American Academy of Hospice and Palliative Medicine. All rights reserved.

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