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

To examine trends in hospice service use and distribution of place of death, as well as their associated factors in the United States (US). A retrospective data analysis based on the US Health and Retirement Study between 1st January 2002 to 31st December 2020. 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). 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.