Physicians slightly more likely to die at home or hospice

1. In this cross-sectional study, physicians were slightly more likely to die at home or in hospice than both the general population and individuals in other professions.

2. The largest absolute differences between physicians and other professional groups were observed when Alzheimer disease or stroke was the underlying cause of death.

Evidence Rating Level: 3 (Average)

Study Rundown: Death occurring at home or in hospice is often linked to a more positive patient experience and reduced use of high-intensity medical interventions compared with dying in a hospital setting. Given their medical knowledge and firsthand experience with serious illness, physicians might be expected to preferentially choose home or hospice settings for their own end-of-life care. However, prior research has suggested that physicians do not differ substantially from other highly educated individuals in this regard. This study evaluated whether physicians are more likely to die at home or in hospice than individuals in the general population and other professional groups. Analyzing data from 2020 to 2023, the authors observed that physicians had a slightly higher, though not statistically significant, proportion of deaths occurring at home or in hospice compared with the general population and with professionals such as lawyers, engineers, scientists, registered nurses, and other health care workers. This trend remained consistent across leading causes of death, including cancer, cardiovascular disease, respiratory illness, neurodegenerative disorders, stroke, and COVID-19. The study has important limitations, including reliance on self-reported data and the inability to adjust for potential confounders such as income, education, and insurance status. Overall, the findings suggest that physicians may be slightly more likely than others to die at home or in hospice. However, the relatively small differences observed imply that medical expertise alone may not be the primary factor shaping end-of-life location, and that broader social and structural influences likely play a significant role.

Click to read this study in AIM

Relevant Reading: Association of Occupation as a Physician With Likelihood of Dying in a Hospital

In-Depth [cross-sectional study]: This cross-sectional study evaluated whether physicians were more likely to die at home or in hospice compared with the general population and individuals in other professions. Data were drawn from the National Vital Statistics System and included adults older than 30 years who died between 2020 and 2023. Available variables comprised underlying cause of death, demographic characteristics, place of death, and usual occupation. Deaths attributable to external causes were excluded from the analysis. During the study period, 11,168,169 deaths were recorded, of which 45,424 (0.4%) occurred among physicians. After statistical adjustment, 44.2% (95% confidence interval [CI], 43.7%–44.6%) of physicians died at home or in hospice. In comparison, the proportion was 40.6% (95% CI, 40.6%–40.6%) in the general population; 41.1% (95% CI, 41.0%–41.3%) among lawyers, engineers, and scientists; 41.8% (95% CI, 41.6%–41.9%) among registered nurses; and 41.8% (95% CI, 41.4%–42.2%) among other health care practitioners. Patterns were similar across the six leading causes of death. Physicians had the highest proportion of deaths occurring at home or in hospice for cancer (64.3% [95% CI, 63.4%–65.2%]), lower respiratory diseases (52.3% [95% CI, 48.8%–55.8%]), heart disease (47.4% [95% CI, 46.4%–48.3%]), Alzheimer disease (44.4% [95% CI, 42.2%–46.5%]), stroke (41.9% [95% CI, 40.1%–43.7%]), and COVID-19 (13.0% [95% CI, 11.9%–14.1%]). Overall, these findings indicate that although physicians were somewhat more likely than other professional groups and the broader population to die at home or in hospice, the differences were modest. The results suggest that medical training and professional experience may influence end-of-life location to a limited extent, but other social, structural, and health system factors likely play an important role.

Image: PD

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