Disparities in Place of Death for Patients with Primary Brain Tumors and Brain Metastases in the United States

Abstract

Purpose Patients with primary or metastatic brain tumors often require intensive end-of-life care, for which place of death may serve as a quality metric. Death at home or hospice are considered a more ‘ideal’ location. Comprehensive information on place of death of people with brain tumors is lacking. Methods Using CDC Wonder Database data, those who died in the U.S. from a solid cancer from 2003 to 2016 were included and place of death for those with primary brain, brain metastases, and solid non-brain tumors were compared. Multivariate logistic regression tested for disparities in place of death. Results By 2016, 51.1% of patients with primary brain tumors and 45.2% with brain metastases died at home. 15.9% of patients with primary brain tumors and 23.6% with brain metastases died in the hospital. Black patients were least likely to die at home or hospice. For patients with primary brain tumors, being married (OR = 2.25 (95%CI 2.16–2.34), p < 0.01) and having an advanced degree (OR = 1.204 (95%CI 1.15–1.26), p < 0.01) increased odds of home/hospice death; older age (OR = 0.50 (95%CI 0.46–0.54), p < 0.01) decreased odds for home/hospice death. For patients with brain metastases, being married (OR = 2.19 (95%CI 2.11–2.26), p < 0.01) increased odds of home/hospice death and male sex (OR = 0.87 (095%CI .85–0.89), p < 0.01) and older age (OR = 0.59 (95%CI 0.47–0.75), p < 0.01) decreased odds of home/hospice death. Conclusion Although the trends are improving, disparities exist in place of death in the brain tumor population. Focused interventions are indicated to increase the utilization of hospice in those with metastatic cancer, under-represented minority groups, and the elderly population.