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Socio-spatial disparities in place of death of dementia decedents in the United States

Authors: Wei Xu*, University of Wisconsin Madison, Changshan Wu, University of Wisconsin Milwaukee, Jason M. Fletcher, University of Wisconsin Madison
Topics: Medical and Health Geography
Keywords: dementia, place of death, disparities
Session Type: Paper
Presentation File: No File Uploaded


As dementia mortality in the U.S. increases, providing quality and equitable end-of-life care for dementia patients has become a major public health challenge. Studies suggest that place of death may be an indicator of quality of end-of-life care. Using nationwide population-based death certificates during 2000 and 2014, we examined the socio-spatial disparities in place of death of dementia decedents in the U.S. State fixed effects models were carried out to assess the associations between place of death of dementia decedents and state-level factors, particularly availability of health care facilities and public health insurance expenditures. Decedents were increasingly more likely to die at home and other places and less likely to die at institutional settings over the study period. There is wide variability between states in the proportions of deaths at different places. Among state-level factors, nursing home bed availability was positively associated with nursing home/long-term care deaths and negatively associated with home deaths. The increase in Medicaid expenditure on institutional long-term supports and services was associated with higher rates of nursing home/long-term care deaths and lower rates of home deaths; while increased Medicaid expenditure on home and community-based services was associated with higher rates of home deaths. States may continue to restrict institutional care facility resources and invest in home and community-based services to shift dementia deaths from institutional settings to homes and communities. As the site of end-of-life care changes, additional measures should be taken to ensure the quality of care at home.

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