Trends in preferred place of death for metastatic melanoma patients in the United States from 2015 to 2024: Analysis of CDC WONDER database.

Abstract

e21523 Background: Metastatic melanoma (MM) is a leading cause of skin cancer-related mortality, necessitating a better understanding of end-of-life care to improve quality and equity. Identifying the preferred place of death (PPOD) informs palliative care strategies, reduces healthcare costs, and enhances patient-centered care. This study evaluates trends in PPOD and hospice utilization for MM patients in the United States from 2015 to 2024 using the CDC WONDER database. Methods: Data on MM-related deaths were collected from the CDC WONDER database for the period January 1, 2015, to December 31, 2024, using ICD-10 code C43: malignant melanoma of skin. Deaths were stratified by PPOD, including hospice facilities, medical facilities, and home. Analyses was done considering demographic variables (age, race, and region) and annual trends, with specific attention to disparities and changes over time. Results: From 2015 to 2024, a total of 74,236 MM-related deaths were recorded. Hospice utilization increased steadily from 5.2% in 2015 to 14.3% in 2024, despite a temporary decline to 11.2% in 2020, likely due to the COVID-19 pandemic. The majority of deaths occurred in medical facilities (54.7%), followed by hospice facilities (28.4%) and at home (16.9%). Racial disparities in PPOD were observed, with African-American (AA) and Native American (NA) groups more likely to die in medical facilities (65.3% and 58.9%, respectively) compared to Whites (51.2%), while Whites exhibited higher hospice utilization (32.4%) than AAs (21.7%) and NAs (18.5%). Younger patients (25–44 years) showed higher hospice utilization (18.9%) compared to those aged 45+ years (12.3%). Geographic variation revealed the highest hospice utilization in California (31.6%) and the lowest in Mississippi (4.8%). Conclusions: To our knowledge, this is the first study utilizing the CDC WONDER database to analyze PPOD in MM-related deaths. This analysis demonstrates a steady increase in hospice utilization among metastatic melanoma patients over the decade, interrupted briefly in 2020, with continued growth thereafter. Racial and geographic disparities in end-of-life care highlight inequities, with African-American and Native American populations more likely to die in medical facilities and less likely to access hospice care compared to Whites. Younger patients also showed greater hospice utilization, reflecting evolving trends in palliative care practices. These findings underscore the need for targeted policy interventions to promote equitable access to hospice services and improve end-of-life care for metastatic melanoma patients in the United States.