Trends in Location of Death for Individuals with Primary Ocular Cancer in the United States.

Abstract

Purpose: Individuals with ocular cancer (OC) face unique end-of-life (EOL) challenges, including potential vision loss and poor prognosis. Place of death significantly impacts the quality of EOL care, and most patients express a preference for dying at home. Understanding where patients with OC die is crucial for assessing care quality and equity.

Methods: Participants included all 5,196 US decedents from 2003 to 2020 whose underlying cause of death was listed as ocular cancer (ICD-10 codes C69.0-C69.9).

Results: Of the 5,196 decedents with OC, 2,824 (54.3%) died at home, 912 (17.6%) in hospitals, 607 (11.7%) in nursing facilities, 523 (10%) in hospice, and 330 (6.4%) in outpatient or emergency department facilities. Compared to patients aged 64 or younger, patients aged 85 or older were significantly less likely to die in a hospital (OR: 0.32 [95% CI: 0.24-0.43]) and at home (OR: 0.67 [95% CI: 0.56-0.80]), but markedly more likely to die in a nursing facility (OR: 8.30 [95% CI: 6.27-10.99]). Significant racial disparities were found; compared to White patients, Black (OR: 2.75 [95% CI: 1.93-3.90]), Asian (OR: 2.56 [1.57-4.17]), and Hispanic (OR: 1.90 [1.42-2.55]), patients were all significantly more likely to die in a hospital. Black patients were also less likely to die at home (OR: 0.59 [95% CI: 0.42-0.83]).

Conclusions: Significant sociodemographic disparities exist in the location of death for patients with OC, particularly by age and race. Patients from racial and ethnic minority groups are disproportionately more likely to die in hospitals and less likely to die at home, suggesting potential inequities in access to preferred EOL care.