Sociodemographic disparities in the place of death in patients with colorectal cancer: Analysis of real-world CDC WONDER data.

46 Background: Most patients with advanced colorectal cancer (CRC) prefer death at home or in hospice, but Place of Death (PoD) disparities remain poorly understood. We performed a retrospective study to examine the sociodemographic differences in PoD among U.S. CRC patients from 2003 to 2020. Methods: We analyzed de-identified death certificate data from the CDC WONDER database for CRC deaths from 2003 to 2020 using ICD-10 codes C18, C19, and C20. PoD patterns and Average Annual Percentage Change (AAPC) across sociodemographic groups were calculated. Results: A total of 939,894 decedents were identified, out of which 488,133 (51.9%) were males, 657,481 (70.0%) were aged ≥ 65, 783,048 (83.3%) were White, 124,375 (13.2%) were Black or African-American, and 60,210 (6.4%) were Hispanic. From 2003 to 2020, deaths in medical facilities decreased from 18,121 (32.7%) to 10,581 (20.7%), and hospice deaths increased from 346 (0.6%) to 5,998 (20.5%)—AAPC of -2.9% and 15.3%, respectively. Trend in hospice utilization between 2003-2020 was similar between African American and White individuals—AAPC of 16.28% and 15.77% respectively (p=0.88). In 2020, males were less likely to die in a nursing home (9.2% vs 11.3%) and more likely in a medical facility (22.1% vs 18.6%); female facility deaths declined faster (AAPC -3.39% vs -2.45%, p