Abstract
<title>Abstract</title> <p>Background Place of death can inform population-level planning for serious-illness care, but it does not directly measure care quality, patient preference, hospice enrollment, palliative-care consultation, or goal-concordant care. Melanoma-specific national data on end-of-life location patterns are limited. We examined place of death and sociodemographic differences among US adults with cutaneous malignant melanoma listed on death certificates. Methods We conducted a retrospective cross-sectional study using National Center for Health Statistics Multiple Cause of Death data from 2003 to 2019. Adults aged 25 years or older with International Classification of Diseases, Tenth Revision code C43 listed as an underlying or contributing cause of death were included if the underlying cause of death was natural. Descriptive proportions were generated from CDC WONDER aggregate output. Individual-level public-use mortality records were used to fit multivariable one-versus-rest logistic regression models estimating adjusted odds of inpatient, outpatient/emergency room, home, hospice-facility, and long-term care death. Results Among 163,388 decedents, home was the most common place of death (44.6%), followed by inpatient hospital (23.3%), long-term care (14.5%), hospice facility (10.0%), and outpatient/emergency room (1.5%). Hospice-facility deaths increased from approximately 1% in 2003 to 17% in 2019, while home deaths declined from 50% to 41%. Compared with non-Hispanic White decedents, non-Hispanic Black decedents had higher adjusted odds of inpatient death (odds ratio [OR], 1.95; 95% confidence interval [CI], 1.79–2.13) and outpatient/emergency room death (OR, 2.23; 95% CI, 1.75–2.85), and lower odds of home death (OR, 0.70; 95% CI, 0.64–0.77). Compared with married decedents, divorced, widowed, and single decedents had lower odds of home death and higher odds of long-term care death. Conclusions End-of-life locations among adults with cutaneous melanoma listed on death certificates shifted substantially from 2003 to 2019 and differed by race/ethnicity, marital status, and age. These national patterns identify populations for earlier serious-illness communication, caregiver-capacity assessment, and equitable care-planning pathways in melanoma care.</p>