Dying at Home Due to Coronavirus Disease 2019

Abstract

Background. Coronavirus disease 2019 (COVID-19) is a leading cause of US deaths and when severe requires admission to a hospital; however, 9% of US COVID-19 deaths before 2022 occurred at home. Methods. Death certificate data were used to examine the cumulative probability of dying at home from COVID-19 and from any cause in North Carolina, including by race and ethnicity. Results. Between March 1, 2020 and December 31, 2021, 22 646 COVID-19 deaths were recorded in North Carolina; of these, 1771 (7.8%) occurred at home. Cumulative risk of dying at home with COVID-19 increased from 3.3/100 000 on December 31, 2020 to 13.0/100 000 on December 31, 2021. After standardizing each racial/ethnic group, cumulative at-home COVID-19 mortality among Hispanic people compared to White people was 9.9/100 000 versus 2.3/100 000, respectively, at year-end 2020 (difference, 7.6/100 000; 95% confidence interval [CI], 5.6-9.6) and 19.0/100 000 versus 11.4/100 000 at year-end 2021 (difference, 7.6; 95% CI, 4.9-10.4). At-home mortality among Black people was also elevated compared to White people (difference, 5.6/100 000; 95% CI, 3.7-7.4) at year-end 2021. Rates of dying at home from any cause increased overall but were greatest among Hispanic people. Conclusions. By the end of 2021, the risk of dying at home from COVID-19 increased, especially for persons of color. The risk of dying at-home from any cause also increased for all but more so for Hispanic persons. These findings suggest perennial barriers to care prevent those with progressive COVID-19 from accessing medical attention and the need for initiatives that extend healthcare access for those disproportionately impacted by COVID-19 to prevent avoidable death.