Where cancer patients die: an epidemiologic study

In a sample of deaths among cancer patients, the relationship of place of death to age, sex, length of time between diagnosis and death, cancer site, and patients' socioeconomic status was investigated. The Rochester (N.Y.) Regional Tumor Registry provided these data for all cancer patients who died in Monroe County, N.Y., during 1976, 1977, and 1978. Patients who had not been residents of the county were excluded from the sample, as were patients under 15 years of age at death and those whose cancers had been diagnosed only at autopsy. Analysis with a logit model was used to estimate odds ratios that compared the probabilities of death in an acute care hospital and in a chronic care facility with the probability of death at home. Patients whose cancers had been diagnosed less than 1 month before their deaths were significantly more likely to die in a hospital than were patients whose cancers had been diagnosed earlier. Cancer sites, too, were significantly related to place of death: persons with leukemia or lymphoma were most likely to die in a hospital, followed by patients with lung, breast, and upper gastrointestinal tract cancers; persons with colorectal, genitourinary, and miscellaneous cancers were most likely to die at home. The patients whose deaths were studied were classified by socioeconomic area (SEA) ranking. Patients who had resided in higher level SEAs were more likely to die at home than those from lower level SEAs; however, this trend was reversed among patients from the lowest level SEAs, who had a relatively high rate of death at home and a low rate of death in chronic care facilities.