National Trends in Location of Death in Patients With End‐Stage Liver Disease

Abstract

Despite improvement in the care of patients with end‐stage liver disease (ESLD), mortality is rising. In the United States, patients are increasingly choosing to die at hospice and home, but data in patients with ESLD are lacking. Therefore, this study aimed to describe the trends in location of death in patients with ESLD. We conducted a retrospective cross‐sectional analysis using the Centers for Disease Control and Prevention Wide‐Ranging OnLine Data for Epidemiologic Research from 2003 to 2018. Death location was categorized as hospice, home, inpatient facility, nursing home, or other. Comparisons were made between sex, age, ethnicity, race, region, and other causes of death. Comparisons were also made between rates of change (calculated as annual percent change), proportion of deaths in 2018, and multivariable logistic regression. A total of 535,261 deaths were attributed to ESLD—most were male, non‐Hispanic, and White. The proportion of deaths at hospice and home increased during the study period from 0.2% to 10.6% and 20.3% to 25.7%, respectively. Whites had the highest proportion of deaths in hospice and home. In multivariable analysis, elderly patients were more likely to die in hospice or home (odds ratio [OR], 1.20; 95% confidence interval [CI], 1.07‐1.35), whereas Black patients were less likely (OR, 0.58; 95% CI, 0.46‐0.73). Compared with other causes of death, ESLD had the second highest proportion of deaths in hospice but lagged behind non–hepatocellular carcinoma malignancy. Deaths in patients with ESLD are increasingly common at hospice and home overall, and although the rates have been increasing among Black patients, they are still less likely to die at hospice or home. Efforts to improve this disparity, promote end‐of‐life care planning, and enhance access to death at hospice and home are needed.

Area Deprivation Index and Gut-Brain Axis in Cirrhosis

“…This is relevant because cirrhosis and chronic liver disease are a sum of associated factors such as obesity, alcohol, and drug use that are strongly rooted in neighborhood disadvantage ( 15 , 29 , 30 ). These factors could impair access to health care, affect dietary habits, affect acceptance and response to medications or therapy, and therefore affect important clinical and psychosocial outcomes ( 4 , 15 , 17 , 31 – 33 ). Cognitive impairment in cirrhosis due to HE is related to gut bacterial changes, and this complication also has the highest negative impact on daily function and economic status ( 22 ).…”

Rural-Urban Disparities in Mortality From Cirrhosis in the United States From 1999 to 2019

“…US Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research database was used to analyze cirrhosis mortality from 1999 to 2019. Cirrhosis was identified as the underlying cause of death from International Classification of Diseases-10 codes for any diagnosis of cirrhosis (K70.3, K71.7, K74.4, K74.5, and K74.6) (2). Using the National Center for Health Statistics Urban-Rural Classification Scheme and the 2013 US census classification, we created 3 population categories: large metropolitan (≥1 million), medium/small metropolitan (50,000–999,999), and rural (<50,000) areas (3).…”

Cultural humility and end‐of‐life communication with people with advanced liver disease

“…Liver disease is the 11th leading cause of death among U.S. adults overall, but is the 4th and 7th leading cause of deaths among American Indian/Alaska Native and Hispanic individuals, respectively 1 . Black, Asian, American Indian/Alaska Native, and Hispanic patients with advanced liver disease also have significantly lower odds of dying at home, or with hospice or specialty palliative care compared to White patients 2,3 . It is unclear whether these findings reflect disparities in health‐care delivery, access, and communication; differences in care; or communication preferences among different groups, or a combination of factors 4 …”