How and where do centenarians die? implications for public health

Background: The centenarian population is growing, yet little is known about where and how centenarians die. This study examines: 1) place and leading causes of death among centenarians, and 2) implications for healthcare systems. Methods: The sample included 119 community-dwelling centenarians who participated in the Georgia Centenarian Study (mean age of death 103.1 ± 2.4; 73.9% females; 76.5% White, 23.5% Black). Death certificate data was retrieved and coded as underlying cause of death based on the International Classification of Diseases (ICD-9). We used descriptive statistics, chi-square and Fisher's exact test to examine the association of cause of death, place of death, and demographics. Results: Leading causes of death were: Heart disease (33.6%); Respiratory diseases (14.3%); Stroke (10.1%); Ill-defined conditions (old age/senility/senescence/natural, 9.2%); Other circulatory diseases (6.7%); Malignancy (5%); Sepsis (2.5%); Genitourinary (2.5%), Nervous system (2.5%), and Injury (2.5%). Two-thirds died in hospitals, with about equal numbers dying in nursing homes (16.8%) or at home (17.6%). Significantly more Black centenarians died in hospitals; none died in nursing homes. There were no significant gender, education, religion, or marital status associations with place of death. Conclusion: This study highlights important characteristics in the cause of death in centenarians. While malignancy and diabetes are the second and sixth leading causes of death in adults 65 and older, a striking difference was the low cause-specific mortality from these diseases among centenarians. The majority of deaths occurred in institutions, which may adversely affect quality of death and has important implications for healthcare costs.