Where the Young Go to Die: A National Study of Place of Death for Young Adults With Gastrointestinal Cancers

INTRODUCTION: Place of death is a crucial marker of end-of-life care quality. Despite rising rates of young-onset gastrointestinal (GI) cancers, patterns in the place of death among these patients remain understudied. We examined temporal trends in place of death in patients with young-onset GI cancers. METHODS: This retrospective cohort study analyzed CDC WONDER mortality data (1999-2020) for individuals aged 18-49 y with GI cancers listed as a cause of death. Places of death were categorized as outpatient/emergency room (ER), inpatient medical facility, hospice/nursing home, or home. Temporal trends in location of death were analyzed and multinomial logistic regression evaluated demographic factors. RESULTS: Among 173,002 young-onset GI cancer-related deaths (median age 41 y; 61.0% male), inpatient deaths declined between 1999 and 2020, with a corresponding rise in home deaths. Overall, 45.4% of deaths occurred at home and 37.6% in inpatient settings. Young Black patients had higher odds of dying in outpatient/ER settings (odds ratio [OR]: 1.42, 95% confidence interval [CI]: 1.32-1.52) than White patients, but lower odds of dying at home (OR: 0.53, 95% CI: 0.51-0.54) or in hospice/nursing homes (OR: 0.73, 95% CI: 0.70-0.76). Women had increased odds of home (OR: 1.04, 95% CI: 1.02-1.06) and hospice/nursing home (OR: 1.08, 95% CI: 1.04-1.11) deaths. Residents of medium/small metropolitan areas had higher odds of outpatient/ER (OR: 1.08, 95% CI: 1.00-1.15) and home (OR: 1.23, 95% CI: 1.20-1.26) deaths. CONCLUSIONS: Among young-onset GI cancer decedents, Black individuals, men, and residents of large metropolitan areas were less likely to experience home death, suggesting potential inequities in access to preference-aligned end-of-life care.