Where the final day is spent: patterns in place of death among U.S. adults with alcoholic liver cirrhosis, 1999-2023.

BACKGROUND: Alcoholic liver cirrhosis (ALC) remains a leading cause of liver-related mortality in the United States (U.S.); however, national data on place of death and sociodemographic patterns are limited. This study aimed to evaluate 25-year national trends in ALC-related mortality and place of death and to examine demographic and geographic predictors shaping end-of-life outcomes. METHODS: Using CDC WONDER death certificate data and the National Center for Health Statistics individual-level mortality files, we analyzed deaths among adults aged ≥25 years (1999-2023). Place of death was categorized as hospital, home, hospice, or nursing home/long-term care; emergency/outpatient deaths were examined separately. RESULTS: From 1999 to 2023, 302 815 ALC-related deaths occurred. Inpatient deaths fell from 65.2 to 48.6%, while home deaths rose from 20.7 to 30.2%. Hospice/nursing facility deaths increased to 23.7% in 2015, then declined to 18.3% in 2023; emergency/outpatient deaths decreased from 4.1 to 2.8%. Ages 50-64 accounted for most deaths, and younger adults had the highest inpatient proportion. In multivariable models, sex, race/ethnicity, and urbanization were significant: men, racial/ethnic minorities, and metropolitan residents were more likely to die in inpatient or emergency settings. CONCLUSION: ALC-related deaths shifted from inpatient facilities toward home and the combined hospice/long-term care facility category, while sociodemographic differences in place of death suggest uneven end-of-life care pathways and support efforts to improve equitable palliative and supportive care planning.