The percentage of US deaths occurring in hospitals decreased by approximately 10% from 2003 to 2017, according to findings from a study published in the New England Journal of Medicine.

This study used data from the Centers for Disease Control and Prevention (CDC) and the National Center for Health Statistics to evaluate the settings of natural death — defined as death due to a medical condition — that occurred in the United States from 2003 to 2017.

Of the nearly 35.2 million natural deaths occurring during this time period, 29.3%, 24.5%, 10.5%, 7.9%, and 5.9% were attributed to cardiovascular disease, cancer, respiratory disease, dementia, and stroke, respectively.


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Although 39.7% of total natural deaths occurred in a hospital setting during 2003, this percentage dropped to 29.8% in 2017. In contrast, deaths at home increased from 23.8% in 2003 to 30.7% in 2017.

“Home has surpassed the hospital as the most common place of death in the [United States] for the first time since the early 20th century,” the study authors noted.

Furthermore, deaths while receiving hospice care increased from 0.2% in 2003 to 8.3% in 2017.

Although these trends were observed across all disease groups, patients with cancer had the highest odds of death at home and in hospice and the lowest odds of dying in a nursing facility compared with patients with other causes of death.

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Overall, the odds of dying at home were lower for younger patients, female patients, and racial/ethnic minorities compared with older patients, male patients, and white patients.

The study researchers commented that “the trends noted here represent progress; however, more information about the experience of patients dying at home is needed to develop policies and services that ensure high-quality end-of-life care. These findings should lead to prioritizing improvements in access to high-quality home care for older Americans with serious illnesses.”

Reference

Cross SH, Warraich HJ. Changes in the place of death in the United States. N Engl J Med. 2019;381(24):2369-2370.