Research from the past two decades shows that fewer Americans are dying in hospitals, and more are dying at home and in nursing homes. When researchers from the National Institutes of Health looked at more than 35 million death certificates issued during the years 1980-1998, they discovered that the proportion of patients dying as hospital inpatients dropped from 54% to 41%. During the same period, the proportion of deaths both at home and in nursing homes increased. Home deaths rose from 17% in 1980 to 22% in 1998, and nursing home deaths rose from 16% to 22% during that period.
The researchers found that the shift applied to both men and women, and the largest shift occurred for patients dying from cancer. The proportion of cancer patients who died in hospitals dropped from 70% to 37%.
One of the most significant shifts related to race. In 1980, statistics showed that 54% of both blacks and whites died in hospitals. By 1998, researchers say, 48% of blacks were still dying in hospitals, while only 40% of white patients died there. Deaths among females showed the greatest racial divergence, with half of black women dying in hospitals and only 39% of white women dying there.
The researchers, writing in the May/June issue of the journal Health Affairs, said they could not say for certain why the racial disparity existed, with possible reasons including a preference among blacks for hospital death, an unwillingness among blacks to sign advance directives, or the fact that blacks have more limited access to hospice and home health agencies.