Primary Submission Category: Aging
Associations of place of death with prevalence of social risks: Findings from the Detroit Research on Cancer Survivors (ROCS) study.
Authors: Jamaica Robinson, Nora Akcasu, Theresa Hastert,
Presenting Author: Jamaica Robinson*
Background: Home has surpassed the hospital as the most common place of death in the United States–especially for patients with cancer. While prior evidence suggests low socioeconomic status cancer patients are less likely to have a home-based death, little is known about how the prevalence of social risks, which are common among cancer patients with the fewest financial resources, differs by place of death.
Methods: Our analyses included 119 decedents who were diagnosed with advanced cancer and who participated in the Detroit Research on Cancer Survivors (ROCS) population-based cohort of Black cancer patients within the 12 months prior to their death. We measured social risks(i.e., housing instability, food insecurity, utility shutoffs, neighborhood safety, and not seeking health care because of cost or a lack of transportation) using decedents’ last follow-up survey. We assessed place of death via death certificates, categorizing decedents as dying at home or in a hospital. We used modified Poisson models to estimate prevalence ratios(PR) and 95% confidence intervals(CIs) of place of death with social risks, controlling for sociodemographic and cancer-related factors.
Results: Fifty-two percent of decedents experienced a home-based death, and nearly 37% of decedents reported experiencing ≥1 social risk within the year prior to death. The relative prevalence of reporting ≥1 social risk was marginally lower for those who died at home versus in hospital(PR:0.95; 95% CI:0.59-1.51); however, the relative prevalence of housing instability, food insecurity, and transportation insecurity was modestly greater for those who died a home- versus hospital-based death.
Conclusion: The burdens of specific social risks were greater for Black cancer decedents who died at home versus in a hospital. Community engaged social work and supportive care planning may present opportunities to screen for and address these social risks for cancer patients experiencing a home-based death.