S2655 Where the Final Day Is Spent: National Patterns in Place of Death Among Adults With Alcoholic Liver Cirrhosis

Introduction: Alcoholic liver cirrhosis (ALC) is a major cause of mortality in the United States (U.S.) with rising death rates over recent decades. Despite the growing burden, limited data exists on where adults with ALC spend their final days. This study aimed to analyze national patterns of death among adults with ALC. Methods: Mortality data for individuals aged >25 years with ALC listed as the underlying cause of death from 1999-2023 were obtained from the CDC WONDER database. Places of death were categorized as inpatient medical facilities, outpatient/emergency settings, home, or hospice/nursing facilities. Joinpoint regression was used to assess trends in ALC-related mortality and place of death by estimating the Annual Percent Change (APC) in rates over time. Multinomial logistic regression analyzed demographic predictors of death location. Results: From 1999-2023, 302,815 deaths were attributed to ALC in the U.S. Mortality increased steadily from 1999 to 2009 with an APC of 3.17 (95% confidence interval (CI): 1.54 to 5.51), followed by a sharper rise from 2009 to 2015, where the APC nearly doubled to 7.80 (95% CI: 1.62 to 11.2). However, between 2015 and 2018 the rate of increase slowed to an APC of 4.54 (95% CI: 2.65 to 6.86). Afterward, from 2018 to 2021 there was a marked acceleration in mortality, with the APC rising significantly to 12.8 (95% CI: 10.6 to 14.8). Finally, a decline in deaths occurred between 2021 and 2023 with the APC decreasing to -4.75 (95% CI: -7.46 to -2.21). The proportion of deaths occurring in inpatient medical facilities decreased from 65.2% in 1999 to 48.6% in 2023, and in emergency rooms from 4.1% to 2.8%. Conversely, the proportion of deaths at home increased from 20.7% to 30.2%. Hospice/nursing facility deaths rose from 10% in 1999 to 23.7% in 2015, then declined to 18.3% by 2023, suggesting shifts in end-of-life care. Gender, race, and urbanization influenced the place of death, with men, Asians individuals, and those in large metropolitan areas being more likely to die in outpatient medical facilities. Conclusion: The place of death among alcoholic liver cirrhosis patients has shifted notably, with home deaths rising and hospital and hospice deaths declining. These changes, along with sociodemographic disparities, highlight the need to address barriers to equitable end-of-life care.