Minorities, men, and unmarried amyotrophic lateral sclerosis patients are more likely to die in an acute care facility

Abstract

Studies suggest that dying at home is a more favorable experience. This study investigated where amyotrophic lateral sclerosis (ALS) patients die and the patient demographics associated with dying in an acute care facility or nursing home compared to home or hospice. Centers for Disease Control and Prevention Multiple Cause Mortality Files from 2005 to 2010 were used to identify ALS patients and to classify place of death. Multinomial logistic regression was used to determine the association between patient demographics and place of death. Between 2005 and 2010, 40,911 patients died of ALS in the United States. Place of death was as follows: home or hospice facility 20,231 (50%), acute care facility (25%), and nursing home (20%). African Americans (adjusted multinomial odds ratio (aMOR) 2.56, CI 2.32–2.83), Hispanics (aMOR 1.44, CI 1.30–1.62), and Asians (aMOR 1.87, CI 1.57–2.22) were more likely to die in an acute care facility, whereas females (aMOR 0.76, CI 0.72–0.80) and married individuals were less likely. Hispanics (aMOR 0.68, CI 0.58–0.79) and married individuals were less likely to die in a nursing home. In conclusion, minorities, men, and unmarried individuals are more likely to die in an acute care facility. Further studies are needed to better understand place of death preferences.

Key words::

• End of life care
• amyotrophic lateral sclerosis
• quality of life
• place of death

Acknowledgements

B. C. Callaghan receives research support from NIH K23 NS079417, Impeto Medical, the Katherine Rayner Program, and the Taubman Medical Institute. J. F. Burke receives research support from NIH K08 NS082597. L. E. Skolarus receives research support from NIH K23 NS073685.

Declaration of interest: The authors alone are responsible for the content and writing of the paper.