SCIENCE

Notebook

More Americans Dying at Home

More Americans now die at home or in hospice care than in hospitals, suggesting more attention should be paid to ensuring adequate end-of-life care in non-hospital settings, a new study concludes.

The study also shows that the trend has been much slower for blacks than for whites.

A team led by Ezekiel Emanuel, chairman of clinical bioethics at the National Institutes of Health, scanned 35.2 million death certificates from 1980 to 1998. During that period, the proportion of patients dying as hospital inpatients dropped to 41 percent from 54 percent.

During the same period, the number of deaths at home and in nursing homes rose to 22 percent each, from 17 percent and 16 percent, respectively.

The biggest shift was for cancer patients. The proportion dying in hospitals dropped to 37 percent from 70 percent, and the vast majority now die at home.

The shift from hospital deaths was the same for men and women overall, but it varied by race.

In 1980, the proportion of blacks and whites dying as inpatients was the same: 54 percent. But by 1998, the two races had significantly diverged, with 48 percent of blacks dying as inpatients and 40 percent of whites. The difference was especially strong for women, with 39 percent of white women dying as inpatients compared to 50 percent of black women.

It is not clear, the researchers report in the May/June issue of the journal Health Affairs, whether more blacks die in hospitals because that is their wish -- perhaps because of a greater desire for life-prolonging procedures or an unwillingness to sign advance directives and "do not resuscitate" orders -- or because they are not gaining access to hospice and home care services.

-- Rick Weiss

Life Found Deep Inside Glacier

It is very hard to find places entirely devoid of life. Ice 1.8 miles deep in a glacier might seem a good candidate for a lifeless spot. But now it has to be taken off the list.

At a recent meeting of the American Society for Microbiology, researchers at Pennsylvania State University described their discovery of colonies of bacteria extracted from 120,000-year-old ice cores from a glacier in Greenland.

The bacteria are unusually small, less than one micron in diameter. (A micron is about four hundred thousandths of an inch, and most bacteria are one to 10 microns in size.) They bear some resemblance to an "ultra-micro bacterium," Sphingopyxis alaskensis, found in Arctic waters. Previous researchers may have missed them because the organisms were too small to be captured by the standard filters used to sieve out microbes.

Vanya I. Miteva and Jean E. Brenchley were able to grow the bacteria at temperatures slightly above freezing, proving the microbes are viable. In most cases, the various species continued to form small organisms, and the colonies' growth rates sped up with successive rounds of cultivation.

It's unclear whether the organisms' small size and near-dormant state are innate characteristics or temporary adaptations to the cold, high-pressure and nutrient-poor environment. It's also unclear what the sources of carbon for energy production and nitrogen for protein synthesis may be at those depths in the ice.