BACKGROUND The location of death is an important component of end-of-life care. However, contemporary trends in the location of death for cardiovascular deaths related to heart failure (CV-HF) and comparison to cancer deaths have not been fully examined. METHODS We analyzed data from the Centers for Disease Control and Prevention's Control Wide-Ranging Online Data for Epidemiologic Research database between 2003 and 2017 to identify location of death for CV-HF and cancer deaths. The proportions of deaths that occurred in a hospice facility, home, and medical facility were tested for trends using linear regression. Odds ratios were calculated to determine the odds of death occurring in a hospice facility or home (versus a medical facility) stratified by sex and race. RESULTS We identified 2 940 920 CV-HF and 8 852 066 cancer deaths. Increases were noted in the proportion of CV-HF deaths in hospice facilities (0.2% to 8.2%; Ptrend<0.001) and at home (20.6% to 30.7%; Ptrend<0.001), whereas decreases were noted in the proportion of deaths in medical facilities (44.5% to 31.0%; Ptrend<0.001) and nursing homes (30.8% to 25.7%; Ptrend<0.001). The odds of dying in a hospice facility (odds ratio, 1.79 [1.75-1.82]) or at home (odds ratio, 1.55 [1.53-1.56]) versus a medical facility was higher for whites versus blacks. The rate of increase in proportion of deaths in hospice facilities was higher for cancer deaths (β=1.05 [95% CI, 0.97-1.12]) than for CV-HF deaths (β=0.61 [95% CI, 0.58-0.64]). CONCLUSIONS The proportion of CV-HF deaths occurring in hospice facilities is increasing but remains low. Disparities are noted whereby whites are more likely to die in hospice facilities or at home versus medical facilities compared with blacks. More research is needed to determine end-of-life preferences for patients with HF and identify the basis for these differences in location of death.

中文翻译：

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2003年至2017年美国与心力衰竭相关的心血管疾病死亡率的死亡趋势。

背景技术死亡的位置是临终护理的重要组成部分。但是，关于与心力衰竭（CV-HF）相关的心血管死亡的死亡地点以及与癌症死亡的比较的当代趋势尚未得到充分研究。方法我们分析了2003年至2017年间疾病预防控制中心流行病学研究数据库的远程控制在线数据的数据，以确定CV-HF的死亡地点和癌症死亡人数。使用线性回归测试了临终关怀机构，家庭和医疗机构中发生的死亡比例的趋势。计算赔率，以确定在按性别和种族分层的临终关怀机构或家庭（相对于医疗机构）中发生死亡的几率。结果我们确定了2 940 920 CV-HF和8 852 066癌症死亡。在临终关怀设施中，CV-HF死亡的比例有所增加（0.2％至8.2％； Ptrend <0.001）和在家中（20.6％至30.7％； Ptrend <0.001），而在医院中，CV-HF的死亡比例有所降低医疗设施（44.5％至31.0％； Ptrend <0.001）和疗养院（30.8％至25.7％； Ptrend <0.001）。白人与黑人相比，在临终医疗机构（赔率，1.79 [1.75-1.82]）或在家（赔率，1.55 [1.53-1.56]）中死亡的几率更高。癌症死亡（β= 1.05 [95％CI，0.97-1.12]）的临终关怀设施中死亡比例的增加率高于CV-HF死亡（β= 0.61 [95％CI，0.58-0.64]） 。结论在临终关怀设施中发生的CV-HF死亡比例正在增加，但仍然很低。值得注意的是，与黑人相比，白人更有可能在临终关怀设施或家庭中死于医疗设施。需要更多的研究来确定HF患者的生命终期偏好，并确定这些死亡位置差异的基础。