Trends and factors associated with hospice care utilization and place of death in the United States between 2002 and 2020: a retrospective data analysis based on the health and retirement study.

AIM: To examine trends in hospice service use and distribution of place of death, as well as their associated factors in the United States (US). METHODS: A retrospective data analysis based on the US Health and Retirement Study between 1st January 2002 to 31st December 2020. RESULTS: Our analysis included 12,784 deaths, of which 3,347 (26.18%) received hospice care in the last two years of life. Hospice utilization during this period rose sharply from 6.30% in 2002 to 51.44% in 2020; however, persistent disparities in hospice use were observed among non-cancer patients and rural populations. Concurrently, hospital deaths declined from 42.23% to 26.25%, with corresponding increases in deaths at private homes (from 28.35% to 33.44%) and in hospice facilities (from 4.16% to 10.59%). Compared with hospital deaths, hospice recipients were substantially more likely to die in hospice facilities (RRR = 1748.11, 95% CI 1070.97-2853.37, P < 0.001), at home (RRR = 5.41, 95% CI 4.52–6.47, P < 0.001), or in nursing homes (RRR = 4.17, 95% CI 3.46–5.04, P < 0.001). CONCLUSION: Hospice care utilization increased markedly between 2002 and 2020, reflecting broader acceptance of palliative care and contributing to a shift from hospital deaths to deaths at home or in hospice settings. Persistent disparities in hospice use among non-cancer patients and rural populations, together with the uncertain impact of expanded hospice availability on care quality beyond place of death, warrant further investigation.