Temporal trends and sociodemographic disparities in place of death among adults with pancreatic cancer in the United States (1999–2023).

12035 Background: Location of death is a critical quality metric for pancreatic cancer due to its rapid trajectory and high symptom burden. While home-based hospice is promoted, it is unclear if shifts from hospital death have been equitable. We analyzed 25-year national trends and independent predictors of place of death. Methods: We analyzed CDC WONDER death certificate data (1999–2023) for pancreatic cancer decedents aged ≥20 years (ICD-10 C25.x). Place of death categories: Home, Hospice/Nursing Facility, Inpatient, or Outpatient/ER. We calculated annual trends and used multinomial logistic regression to estimate adjusted odds ratios (aOR) with 95% confidence intervals (CI), adjusting for age, sex, race/ethnicity, urbanization, and year. Inpatient death served as the reference category. Results: Of 899,332 deaths, acute care hospital deaths declined (34.0% to 21.0%) while home (48.6% to 56.1%) and hospice/nursing facility deaths (15.7% to 21.3%) increased. However, significant disparities persisted. Compared to Non-Hispanic Whites, Black patients were less likely to die at home (aOR 0.55; 95% CI, 0.54–0.56) or in hospice/nursing facilities (aOR 0.63; 95% CI, 0.62–0.65) and significantly more likely to die in Outpatient/ER settings (aOR 1.57; 95% CI, 1.51–1.64). Hispanics were less likely to die in hospice/nursing facilities (aOR 0.57; 95% CI, 0.55–0.58). Rural residents had lower odds of hospice/nursing facility death (aOR 0.89; 95% CI, 0.87–0.91) vs. large metro. Younger age (20–64) was associated with hospital death. Conclusions: Despite substantial shifts from hospital to home settings, Black and Hispanic patients remain significantly less likely to access hospice and more likely to die in emergency settings. These findings highlight structural inequities requiring targeted interventions to ensure high-quality end-of-life care for minority populations. Multivariable adjusted odds ratios (aOR) for place of death in pancreatic cancer. Predictor Comparison Decedent's Home (aOR) Hospice/Nursing Facility (aOR) Outpatient or ER (aOR) Black vs. White 0.55 (0.54–0.56) 0.63 (0.62–0.65) 1.57 (1.51–1.64) Asian vs. White 0.74 (0.72–0.76) 0.51 (0.49–0.53) 0.85 (0.77–0.95) Hispanic vs. Non-Hispanic 0.92 (0.90–0.94) 0.57 (0.55–0.58) 1.01 (0.94–1.08) Rural vs. Large Metro 1.08 (1.06–1.10) 0.89 (0.87–0.91) 0.92 (0.88–0.97) Male vs. Female 0.90 (0.89–0.91) 0.78 (0.77–0.79) 1.09 (1.05–1.13) Age 85+ vs. 20–64 1.79 (1.75–1.82) 3.69 (3.61–3.76) 0.66 (0.62–0.71) Age 75–84 vs. 20–64 1.39 (1.37–1.41) 1.91 (1.88–1.94) 0.81 (0.78–0.85) Age 65–74 vs. 20–64 1.18 (1.17–1.20) 1.33 (1.31–1.36) 0.89 (0.85–0.92) Abbreviations: aOR, adjusted Odds Ratio; CI, Confidence Interval; ER, Emergency Room; Ref, Reference Group.