ArticleDigestive diseases and sciences2026
State-Level Variability in Location of Death of Patients with End-Stage Liver Disease.
Article in Digestive diseases and sciences, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeAlthough deaths from end-stage liver disease (ESLD) and hepatocellular carcinoma (HCC) in the United States increasingly occur at home or in hospice, inpatient medical facility deaths remain high. Despite the decrease in in-hospital deaths for all causes, non-White decedents are more likely than White decedents to die in a hospital setting. This study aimed to determine state-level variability in the location of death among patients with ESLD and HCC and to assess racial/ethnic differences in these patterns, focusing on Black, White, and Hispanic/Latino patients.
methodsA retrospective cross-sectional analysis was conducted using 2018-2022 data from the Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research. The proportion of patients with ESLD, HCC, and both conditions who died at an inpatient medical facility, home, hospice facilities, and a combination of both home and hospice was calculated, stratified by race/ethnicity. Mapping was utilized to compare these proportions across the US.
resultsThere was notable geographic variation in the location of death across all groups. Black and Hispanic/Latino patients with ESLD and HCC more frequently died in inpatient facilities compared to White patients. A statistically significant positive correlation was observed between the number of registered hospice agencies in a state and the proportion of deaths occurring at home among White (Spearman's ρ = 0.33, p = 0.02) and Hispanic/Latino patients (Spearman's ρ = 0.38, p = 0.01).
conclusionsFuture research should investigate factors driving interstate variability and racial differences in end-of-life care for ESLD and HCC patients, which may include hospice availability and the presence of palliative care laws. Strategies to reduce these differences and enhance access to quality end-of-life care for all, particularly for racial/ethnic minorities, are needed.
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