Qureshi Imran, Patel Charmi, Rella Steven, Botterman Evan, Abboud Yazan, Goyal Ritik, Hajifathalian Kaveh, Gaglio Paul, Al-Khazraji Ahmed
Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA.
School of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA.
Palliat Support Care. 2025 Jun 20;23:e122. doi: 10.1017/S147895152510031X.
Cholangiocarcinoma (CCA) is the second most lethal primary hepatic malignancy. It has been well-reported that most cancer patients prefer to die at home or in a hospice facility. However, there is limited data on the place of death for CCA patients. We evaluated trends and disparities in place of death for patients with CCA from 1999 to 2020.
Using the CDC WONDER database (1999-2020), we calculated the frequency of CCA deaths at home/hospice and the average annual percentage change (AAPC) over this period stratified by race, age, gender, and region. We employed logistic regression to assess for associations between these variables and place of death for patients whose death was attributed to CCA.
Among 140,422 deaths, a rise in deaths occurred in home/hospice facilities compared to inpatient medical or nursing facilities across all variables examined. Blacks and individuals ≥ 85 had the highest proportion of deaths outside of home/hospice. However, Blacks showed the highest AAPC (8.56%) in home/hospice deaths, followed by Asians (AAPC 8.44%). In contrast, individuals aged 45-54 saw the lowest AAPC (4.27%). Non-whites were less likely to die at home/hospice, with Blacks demonstrating the lowest adjusted odds ratio (aOR 0.64). Those ≥ 85 were less likely to die in home/hospice (aOR 0.78), whereas individuals aged between 55-64 (aOR 1.11) and 65-74 (aOR 1.12) had increased odds of dying in these settings. Patients from the Western region were the most likely to die at home/hospice (aOR 1.04).
Our study highlights disparities in place of death of patients with CCA amongst races, regions, and ages. Non-whites, extremes of ages, and patients from the Northeast have disproportionately poor outcomes in terms of end-of-life care in the US. These findings emphasize the need for efforts to address sociodemographic disparities in end-of-life care to improve patient-centered health outcomes.
胆管癌（CCA）是第二大致命性原发性肝脏恶性肿瘤。已有充分报道称，大多数癌症患者更愿意在家中或临终关怀机构去世。然而，关于CCA患者死亡地点的数据有限。我们评估了1999年至2020年期间CCA患者死亡地点的趋势和差异。
利用疾病控制与预防中心（CDC）的WONDER数据库（1999 - 2020年），我们计算了在家中/临终关怀机构的CCA死亡频率以及在此期间按种族、年龄、性别和地区分层的年均百分比变化（AAPC）。我们采用逻辑回归来评估这些变量与死亡归因于CCA的患者死亡地点之间的关联。
在140,422例死亡病例中，与住院医疗或护理机构相比，在家中/临终关怀机构的死亡人数在所有研究变量中均有所增加。黑人和85岁及以上的人群在家中/临终关怀机构以外的死亡比例最高。然而，黑人在家中/临终关怀机构死亡的AAPC最高（8.56%），其次是亚洲人（AAPC 8.44%）。相比之下，45 - 54岁的人群AAPC最低（4.27%）。非白人在家中/临终关怀机构死亡的可能性较小，黑人的调整后优势比（aOR）最低（0.64）。85岁及以上的人群在家中/临终关怀机构死亡的可能性较小（aOR 0.78），而55 - 64岁（aOR 1.11）和65 - 74岁（aOR 1.12）的人群在这些环境中死亡的几率增加。来自西部地区的患者最有可能在家中/临终关怀机构死亡（aOR 1.04）。
我们的研究突出了CCA患者在种族、地区和年龄方面死亡地点的差异。在美国，非白人患者、极端年龄患者以及来自东北部的患者在临终关怀方面的结局尤其差。这些发现强调需要努力解决临终关怀中的社会人口差异问题，以改善以患者为中心的健康结局。
