Sociodemographic disparities in the place of death in patients with colorectal cancer: Analysis of real-world CDC WONDER data.

46 Background: Most patients with advanced colorectal cancer (CRC) prefer death at home or in hospice, but Place of Death (PoD) disparities remain poorly understood. We performed a retrospective study to examine the sociodemographic differences in PoD among U.S. CRC patients from 2003 to 2020. Methods: We analyzed de-identified death certificate data from the CDC WONDER database for CRC deaths from 2003 to 2020 using ICD-10 codes C18, C19, and C20. PoD patterns and Average Annual Percentage Change (AAPC) across sociodemographic groups were calculated. Results: A total of 939,894 decedents were identified, out of which 488,133 (51.9%) were males, 657,481 (70.0%) were aged ≥ 65, 783,048 (83.3%) were White, 124,375 (13.2%) were Black or African-American, and 60,210 (6.4%) were Hispanic. From 2003 to 2020, deaths in medical facilities decreased from 18,121 (32.7%) to 10,581 (20.7%), and hospice deaths increased from 346 (0.6%) to 5,998 (20.5%)—AAPC of -2.9% and 15.3%, respectively. Trend in hospice utilization between 2003-2020 was similar between African American and White individuals—AAPC of 16.28% and 15.77% respectively (p=0.88). In 2020, males were less likely to die in a nursing home (9.2% vs 11.3%) and more likely in a medical facility (22.1% vs 18.6%); female facility deaths declined faster (AAPC -3.39% vs -2.45%, p<0.0001). In 2020, Hispanic individuals were more likely to die at home (56.8% vs 52.5%), and less likely to utilize hospice (8.1% vs 12%) or die in a nursing facility (5.7% vs 12.6%) compared to non-Hispanics. For the same year, African American individuals were more likely to die in a medical facility (27.6% vs 19%) and less likely to die at home (47.4% vs 53.7%) or in a nursing home (8.9% vs 10.5%) compared to Whites. Compared to White or African American individuals, Native Americans and Pacific Islanders were less likely to utilize hospice (7.9% and 7.5% vs 11.7% vs 11.5%, p<0.001) in 2020. Moreover, in the same year, Younger patients (<65) compared to older patients had higher rates of medical facility deaths (24.9% vs 18.4%), slightly higher hospice use (12.7% vs 11.1%), and a much lower rate of nursing home deaths (4.6% vs 12.9%). Conclusions: Over the past two decades, medical facility deaths have declined and hospice use has expanded, reflecting a major shift in CRC PoD patterns. However, significant disparities still exist, underscoring the need for targeted, equitable strategies to expand access to palliative and hospice care across sociodemographic groups.