Where the final day is spent: patterns in place of death among U.S. adults with alcoholic liver cirrhosis, 1999–2023
Asad Ali Ahmed Cheema, Syed Sarmad Javaid, Fabeha Zafar, FNU Samina, Muhammad Sufian, Muhammad Hamza Saghir, Muhammad Zohaib Qasim, Zainab Pervaiz, Warda Nasir, Muhammad Hashir Khan, Ali Ghaffar, Hamza Bashir, Muhammad Shikaib ShabbirBackground:
Alcoholic liver cirrhosis (ALC) remains a leading cause of liver-related mortality in the United States (U.S.); however, national data on place of death and sociodemographic patterns are limited. This study aimed to evaluate 25-year national trends in ALC-related mortality and place of death and to examine demographic and geographic predictors shaping end-of-life outcomes.
Methods:
Using CDC WONDER death certificate data and the National Center for Health Statistics individual-level mortality files, we analyzed deaths among adults aged ≥25 years (1999–2023). Place of death was categorized as hospital, home, hospice, or nursing home/long-term care; emergency/outpatient deaths were examined separately.
Results:
From 1999 to 2023, 302 815 ALC-related deaths occurred. Inpatient deaths fell from 65.2 to 48.6%, while home deaths rose from 20.7 to 30.2%. Hospice/nursing facility deaths increased to 23.7% in 2015, then declined to 18.3% in 2023; emergency/outpatient deaths decreased from 4.1 to 2.8%. Ages 50–64 accounted for most deaths, and younger adults had the highest inpatient proportion. In multivariable models, sex, race/ethnicity, and urbanization were significant: men, racial/ethnic minorities, and metropolitan residents were more likely to die in inpatient or emergency settings.
Conclusion:
ALC-related deaths shifted from inpatient facilities toward home and the combined hospice/long-term care facility category, while sociodemographic differences in place of death suggest uneven end-of-life care pathways and support efforts to improve equitable palliative and supportive care planning.