Abstract Body:
Background: Pulmonary embolism (PE) is a life-threatening cardiovascular condition with significant mortality. Despite advances in care, limited data exist on place of death (POD) trends and associated disparities. Understanding POD offers insight into healthcare access and end-of-life equity. This study assessed national trends and sociodemographic differences in POD among U.S. adults who died from PE between 1999 and 2023.

Methods: We conducted a retrospective analysis of CDC WONDER mortality data for adults aged ≥25 years with PE (ICD-10 I26) as the underlying cause of death from 1999–2023. POD was categorized as inpatient facility, outpatient/emergency department (ED), home, or hospice/nursing facility. Multivariable multinomial logistic regression was used to assess associations between demographic factors and POD.

Results: A total of 790,088 PE-related deaths were identified. Most occurred in inpatient settings (54.7%), followed by home (17.9%), hospice/nursing facilities (13.8%), and outpatient/ED (13.5%). Adults aged 25–34 years had higher proportions of inpatient (44.6%) and outpatient/ED (36.2%) deaths. Those aged ≥85 years more frequently died in hospice/nursing facilities (29.9%). Black individuals had the highest outpatient/ED deaths (18.5%) and the lowest in hospice/nursing facilities (8.0%). Asian/Pacific Islander individuals had the highest inpatient mortality (64.9%). In multivariable models, Black individuals had significantly lower odds of hospice/nursing facility death compared to White individuals (adjusted odds ratio 0.28, 95% CI: 0.25–0.31). Hospice/nursing facility deaths were more common in medium/small metropolitan areas (15.7%) than in large metro (12.3%) or nonmetro areas (14.4%).

Conclusions: Substantial sociodemographic disparities in POD among PE deaths persist in the U.S. Minority populations and urban residents were less likely to die in hospice or nursing facilities, suggesting inequities in access to end-of-life care. Findings underscore the need for targeted efforts to ensure equitable access to palliative and hospice services for patients with PE.