title: Persistent racial and ethnic differences in location of death for children with cancer.
abstract: BACKGROUND
  Approximately one in 285 children will be diagnosed with cancer before reaching their 20th birthday. While both oncologists and parents report a preference that these children die at home rather than in a hospital, there are limited data exploring this issue in depth.
  
  
  METHODS
  We performed a retrospective analysis of national-level data from 1999 to 2011 from the National Center for Health Statistics "Underlying Cause of Death" database. Characteristics investigated included sex, race, age, ethnicity, cancer type, geographic location, and population density where the child lived.
  
  
  RESULTS
  Of the 2,130 children with a death attributable to neoplasm in 2011, 37.6% (95% CI, 35.5-39.6%) died at home compared to 36.9% (95% CI, 35.0-38.8%) in 1999. In 2011, there were statistically significant racial differences between white, black, and Hispanic children across nearly every age group, with white children consistently most likely to die at home. Children of non-Hispanic origin were significantly more likely to die at home than Hispanic children (40.3% vs. 29.3%, P < 0.001). Children with CNS tumors are more likely to die at home than children with neoplasms as a whole, while children with leukemia are less likely. Statistically significant differences by race and ethnicity persist regardless of cancer type.
  
  
  CONCLUSIONS
  There has been no significant change in the rate of children with cancer who die at home over the past decade. Racial and ethnic differences have persisted in end of life care for children with cancer with white non-Hispanic children being most likely to die at home.
authors: Department of Pediatrics, New York University School of Medicine, New York, New York.
authors: Philip B
authors: PB
authors: Cawkwell
authors: Division of Pediatric Hematology/Oncology; Department of Pediatrics, New York University School of Medicine, New York, New York.
authors: Sharon L
authors: SL
authors: Gardner
authors: Department of Pediatrics, New York University School of Medicine, New York, New York.|Department of Environmental Medicine, New York University School of Medicine, New York, New York.|Global Institute of Public Health, New York University, New York, New York.
authors: Michael
authors: M
authors: Weitzman
mesh_terms: D000293:Adolescent; D001741:Black or African American; D002648:Child; D002675:Child, Preschool; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D054625:Healthcare Disparities; D006630:Hispanic or Latino; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009369:Neoplasms / Q000401:mortality*; D010166:Palliative Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013727:Terminal Care / Q000706:statistics & numerical data*; D014481:United States; D044465:White People
keywords: end of life care; healthcare disparities; palliative care; pediatric oncology; place of death