Place of death patterns among patients with renal cell carcinoma in the United States: A 24-year nationwide analysis.

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Background: Despite advances in targeted and immune-based therapies, renal cell carcinoma (RCC) remains associated with substantial morbidity and mortality. Place of death (PoD) serves as an important marker of end-of-life (EOL) care quality, reflecting access to hospice, palliative services, and health system equity. However, national PoD patterns among RCC decedents have not been well characterized. This study characterizes national PoD patterns and identifies demographic disparities among RCC decedents over a 24-year period in the United States. Methods: We conducted a retrospective, population-based study using the CDC WONDER Multiple Cause of Death database (1999–2023). RCC decedents were identified using ICD-10 code C64. PoD was categorized as decedent's home, hospice facility, medical facility, or nursing home/long-term care facility. Multinomial logistic regression examined associations between demographic characteristics and PoD, with results reported as odds ratios (ORs) and 95% confidence intervals (CIs). Results: Among 329,918 RCC decedents, the age-adjusted mortality rate declined from 6.50 per 100,000 in 1999 to 5.23 per 100,000 in 2023. The proportion of hospice facility deaths doubled from 5.9% to 12.2%, and home deaths also increased from 47.8% to 50.7% from 1999 to 2023. Conversely, the proportion of deaths in medical facility and nursing home/long-term care facility declined from 34.2% and 25.2% in 1999 to 17.9% and 11.8% in 2023 respectively. Younger adults (25–34 years) had the highest proportion of deaths in medical facility, which decreased with advancing age. Significant geographic variations were observed, with the highest proportion of home deaths in the West, and hospice deaths in the South. Compared with White individuals, Black individuals had lower odds of home death (OR 0.54, 95% CI 0.52–0.55) and hospice death (OR 0.78, 95% CI 0.74–0.82). Hispanics had higher odds of home death (OR 1.14, 95% CI 1.11–1.17) but lower odds of hospice death (OR 0.77, 95% CI 0.73–0.81) and nursing home/ long-term care death (OR 0.51, 95% CI 0.48–0.53) compared with non-Hispanics. Non-metropolitan residents were less likely to die in hospice facilities compared with large metropolitan residents (OR 0.44, 95% CI 0.42–0.46). Conclusions: This is the first population-level study on PoD patterns among RCC decedents in the United States, characterized by an evolving national shift toward home and hospice deaths over the last 24 years. However, significant disparities persist across racial and ethnic groups, and geographic regions, suggesting inequities in access to hospice and community-based EOL care. Targeted efforts are warranted to address these disparities in EOL care for patients with RCC.