Geographic variation in hospice use in the United States in 2002

Complete Center for Disease Control death certificate records and Centers for Medicare and Medicaid Services 100% Standard Analytic File for hospice claims for 2002 were used to describe the whole population of hospice users and nonusers in the United States. The overall hospice utilization rate for persons 65 years and older was 28.6%. Hospice utilization varied by cause of death, and was highest for individuals with malignancies (65%), kidney disease and nephritis (55%), and Alzheimer's disease (41%). Hospice utilization was lowest for conditions leading to rapid or unexpected death, such as accidents and suicide (0%), influenza and pneumonia (3%), and sepsis (6%). Considerable geographic differences in hospice utilization existed, with hospice use higher in the South and the Southwest and lower in the Midwest and the Northeast. State-specific usage rates ranged from 8% in Alaska to 49% in Arizona. Our findings highlight opportunities for the hospice industry to provide more care, opportunities defined by diagnostic and geographic axes.