Objective:

To examine whether COVID-19 pandemic altered place of death of MND patients.    

Background:

To date, little information is available on place of death for motor neuron disease (MND) patients in the United States (U.S.) during the COVID-19 pandemic.

Design/Methods:

A population-based cross-sectional analysis was conducted of all U.S. adult MND deaths from two periods: 2018 –2019 (pre-COVID), and 2020–2021 (during COVID years).  We used chi-square tests to examine the association between MND place of death and COVID-19 time periods (pre vs. during).  Using multivariate logistic regression, we modeled the association between place of death with demographic characteristics.  

Results:

The average number of MND deaths statistically increased 6.5% from 15,041 pre-COVID to 16,018 during the COVID years (p<0.0001). Death in decedent's home increased significantly (20.1%, p<0.0001) at 9,117 during COVID years (from 7,593 pre-COVID), and the combined death in nursing homes/hospice facilities decreased 19.3% (from3,552 pre-COVID to 2,977 COVID years).  Among the Hispanic population, there was a statistically significant increased likelihood of dying at home compared to a nursing home/hospice facility during the COVID years (OR=1.57, 95%CI: 1.22-2.02, p=0.0004) against the pre-COVID, non-Hispanic population. The pattern was similar among the White population during COVID years (OR=1.13, 95%CI: 0.94-1.37, p=0.1985), but the likelihood of dying at home was significantly less for the pre-COVID years (OR=0.83, 95%CI: 0.69-0.99, p=0.0358). Among the 10 listed comorbidities, sepsis significantly increased the likelihood of death in nursing homes compared to hospitals or decedent’s home (OR=2.36, 95%CI: 1.37-4.07, p=0.0021). Similarly, diabetes (OR=1.26, 95%CI: 1.03-1.55, p=0.0275) and essential hypertension (OR=1.17, 95%CI: 1.01-1.36, p=0.0345) significantly increased the likelihood of death in decedent’s home compared to nursing home and hospital.

Conclusions: