Abstract P5-02-10: Factors and Trends in Place of Death Among Breast Cancer Patients: A Population-Based Study in Brazil

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Abstract Background: The quality of death serves as an indicator of the quality of care, shaped by factors such as the place of death, access to palliative care, and symptom management. In the context of Brazil, a diverse landscape with regional social disparities can lead to unequal access to healthcare, particularly in breast cancer (BC), which is the leading cause of cancer-related deaths among Brazilian women. Unlike in developed countries, dying at home in Brazil may suggest inadequate end-of-life care. Understanding the patterns of place of death and their association with social inequalities is crucial for developing effective end-of-life care policies for women with breast cancer in Brazil. Methods: This cross-sectional study in Brazil used data from the Mortality Information System (2001-2021) to analyze breast cancer deaths (ICD-10 C50) based on place and year of death. Deaths were categorized as hospital or home deaths, and evaluated variables included age, race, education, marital status, and regional Human Development Index (HDI). Trends in death rates were assessed by using Joinpoint Regression, and the relationship between home deaths and regional HDI was assessed by Pearson correlation. Univariate logistic regressions calculated odds ratios to determine factors influencing home deaths, with statistical significance set at p<0.05. Results: Between 2001 and 2022, there were 303,279 BC deaths in Brazil, with 299,775 cases included in the study after excluding men (3,329) and patients with missing data on sex (17) or place of death (158). Of these, 253,581 (84.6%) occurred in hospitals, while 46,194 (15.4%) occurred at home. Home deaths were more frequent in the Northeastern (15,438, 25.1%) and Northern (2,255, 20.4%) compared to the Southern (8,367, 15.6%), Central-Western (2,647, 14.4%), and Southeastern (17,487, 11.3%) regions. Patients from the lower HDI regions of the North, Northeast, and Central-West had higher rates of home deaths (OR = 2.04, 95% CI = 2.00-2.08) compared to those in the higher HDI Southeastern and Southern regions, showing a strong inverse correlation between home death proportion and regional HDI (Pearson's Correlation Coefficient = −0.932, p = 0.021). Temporal trend analysis indicated a significant continuous reduction in home deaths from 2001 to 2017, decreasing annually by 2.6% from 19.1% to 12.5% (APC = −2.6%, 95% CI = −3.0 to −2.3, p < 0.001). This was followed by an increase to 17.7% in 2020 (APC = 12.4%, 95% CI = 4.3 to 21.2, p = 0.005) and a return to a non-significant decrease to 16.2% by 2022 (APC = −4.3%, 95% CI = -10.4 to 2.2, p = 0.172). Higher rates of BC home deaths were associated with older age (≥ 60) (OR = 1.79, 95% CI = 1.75–1.83), lack of formal education (OR = 3.02, 95% CI = 2.92-3.13), absence of a partner (OR = 1.28, 95% CI = 1.25-1.30), and self-reported ethnicity, with black and mixed-race (OR = 1.14, 95% CI = 1.11-1.16) and indigenous women (OR = 1.92, 95% CI = 1.45-2.56) having higher home death rates compared to white women. Conclusions: The study underscores a high rate of home deaths among BC patients in Brazil, highlighting the absence of national end-of-life care programs and palliative care structures, especially in underdeveloped regions. Home death rates were inversely correlated with regional HDI. Temporal trends showed a continuous reduction in home deaths, with a temporary increase likely linked to the COVID-19 pandemic. Factors such as ethnicity, educational level, and marital status also influenced the place of death. These findings underscore the need for policies addressing the impact of social factors like race, education, and HDI on the location of end-of-life care for BC patients in Brazil. Citation Format: Jesse Lopes da Silva, Natalia Cristina Cardoso Nunes, Livia Costa de Oliveira, Lucas Zanetti de Albuquerque, Pedro Henrique Souza, Andreia Cristina de Melo, Luiz Claudio Santos Thuler. Factors and Trends in Place of Death Among Breast Cancer Patients: A Population-Based Study in Brazil [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P5-02-10.

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