Flying Colours Ltd / Getty Images

Fewer patients may be dying in hospitals, but that doesn't necessarily mean they are getting better. More may be dying in hospices or nursing homes or even at home, experts say.

The number of people who died in the hospital has fallen just 8 percent over 10 years, despite a big emphasis on letting people die in hospice or even at home, new federal statistics show.

And a lot of the decrease appears to be from an overall drop in many types of death, the new report from the National Center for Health Statistics shows.

“People don’t want to die in the hospital – yet a lot of them are,” says NCHS’s Margaret Jean Hall, who led the study with colleagues Shaleah Levant and Carol DeFrances.

The study found another trend – deaths in the hospital from sepsis, an overwhelming immune response to infection or injury, rose 17 percent over those 10 years. Other data shows sepsis cases overall more than doubled over that time.

Hall and her colleagues pulled their data from an annual survey done by the Centers for Disease Control and Prevention on nonfederal, noninstitutional, short-stay hospitals and general hospitals.

“The number of inpatient hospital deaths decreased 8 percent from 776,000 in 2000 to 715,000 in 2010,” they wrote in their report. “At the same time, total hospitalizations increased 11 percent, from 31.7 million in 2000 to 35.1 million in 2010.”

People with several conditions were far less likely to die in a hospital , the team found. “Hospital death rates decreased for patients hospitalized for respiratory failure by 35 percent, for pneumonitis due to solids and liquids by 22 percent, for kidney disease by 65 percent, for cancer by 46 percent, for stroke by 27 percent, for pneumonia by 33 percent, and for heart disease by 16 percent,” they wrote.

“We know that overall death rates are down for some of these conditions … for example, the cancer death rate, the stroke death rate,” Hall said in a telephone interview.

“But it doesn’t necessarily mean we are better at getting people well in the hospital. They could just have gone to a post-acute setting like a nursing home…or even home and they could have died soon after,” she added.

It’s well established that hospitals are not necessarily the best place for people who are dying. They are very expensive places to get care, and staff may be less focused on making patients comfortable than on keeping them alive – even if they are ultimately almost certainly going to die soon.

“Sometimes they get care that is more intensive than what they would have requested,” Hall said.

Hospice care aims to keep patients comfortable when it’s clear that their conditions are incurable. Other alternatives to the hospital for patients who may not necessarily be dying include nursing homes, long-term care facilities and home care.

Theresa Forster, vice president for hospice policy at the National Association for Home Care & Hospice, says while an 8 percent reduction in hospital inpatient deaths over 10 years may not be a huge number, it’s at least moving in the right direction.

“This could be the beginning of significant change,” Forster said in a telephone interview. 

“We are getting a whole lot better but we still have a long way to go,” she added. “I think the American public very much desires there to be more discourse around this whole area, and they want to be talking more with their doctors.”

Forster noted that Congress and the federal government have only recently created financial incentives for hospitals to move dying patients to other facilities, as part of efforts to reduce what are called readmission rates – when patients are discharged, and then wind up right back in the hospital a few days or weeks later.

Last month, CDC reported more people are dying at home. The study looked at Medicare patients – a different population of people than Wednesday’s report covers. It found that 33.5 percent of Medicare patients died at home in 2009, compared to 23 percent in 2000.

As for the findings on sepsis, also known as septicemia, Hall says it’s not clear how much of the rise is due to more cases occurring.

"More people are recognizing sepsis," says Dr. Clifford Deutschman of the University of Pennsylvania, a past president of the Society of Critical Care Medicine. Deutschman says hospitals are doing a better job of classifying deaths from sepsis, a still mysterious condition in which the body's immune system gets out of whack, often killing patients in just hours or days.

Hall and colleagues reported in 2011 that both the number and rate of people hospitalized with sepsis more than doubled from 2000 through 2008, from 326,000 in 2000 to 727,000 in 2008. But if deaths only went up 17 percent over a period two years longer, that could indicate that hospitals are doing a good job of saving sepsis patients. Quick recognition and treatment is key, says the Surviving Sepsis Campaign.

Related:

• Fewer Americans die in acute care hospitals
• What you should know about end-of-life care
• New guidelines stress fast treatment for sepsis
• Device speeds ID of sepsis bacteria

Hurricane Sandy is already stressing millions of people living on the eastern seaboard, but it’s not likely to kill anywhere near the number of people who would have died in such a storm 100 years ago. That’s because weather and emergency officials can get people out of the worst flood zones in time.

So what are the most likely 21^st century causes of death? Carbon monoxide poisoning often leads the list, as people turn to grills and gas stoves in power outages. Flash flooding and storm surges are also big killers.

Each hurricane is different and while a large percentage of deaths are from drowning, it’s not necessarily always the main cause. Heart attacks can also kill people, especially the elderly.

Katrina, which hit the Gulf Coast in 2005, was the deadliest hurricane this century. Officials tried to evacuate residents in low-lying areas, but several hundred people died in Louisiana when levees failed and floodwaters poured in, quickly and silently, as people slept.

Louisiana’s chief health official, Dr. Raoult Ratard, and colleagues counted 971 deaths in Louisiana alone that could be directly blamed on Katrina. Forty percent had drowned, 25 percent of people died from injuries including carbon monoxide poisoning and 11 percent died from heart conditions, which may have been exacerbated by stress or lack of access to medical care. Nearly, half, 49 percent, of the victims were aged 75 or older – showing how the frail are often most at risk.

Carbon monoxide poisoning – usually listed under injuries – killed 10 people in Alabama and Texas after Katrina and a second hurricane, Rita, hit and power went out, often for weeks.

“Few homes had functioning carbon monoxide detectors,” Centers for Disease Control and Prevention and state health officials wrote in a report published afterwards. “CDC continues to recommend that generators be placed far from homes, away from window air conditioners,  and that carbon monoxide detectors be used by all households operating gasoline-powered appliances (e.g., generators and gas furnaces), with batteries replaced yearly.”

Watch now: Multiple live video streams of Sandy coverage

Carbon monoxide is an odorless gas generated when natural gas, gasoline, coal and other fuels are burned. Victims usually don’t notice they are being affected and they can die in their sleep. The first symptom is often sleepiness or nausea, as well as headache.

It can be a problem any time of year but especially during power outages as people turn to other sources to cook and to heat or cool their homes. “Don't run a car or truck inside a garage attached to your house, even if you leave the door open. Don't heat your house with a gas oven,” CDC cautions.

In 2008, Hurricane Ike hit the Texas coast near Galveston, killing 74 people in Texas and Louisiana. The largest percentage were people who died from carbon monoxide poisoning after the storm had passed and left 2.3 million people without power – 13 people died this way, state health offiicials reported. Eight people drowned and 12 died of heart attacks, strokes and other heart-related causes.

Anthony Arguez and James Elsner of Florida State University analyzed hurricane deaths and found that, even though more people live along the coasts, they are far less likely to die in hurricanes than in the days before highways and warning systems made it easy to escape the most dangerous areas.

In the past 100 years or so, they found, hurricanes have killed about 15,000 people – about half of them in 1900 when Galveston, Texas was destroyed by a hurricane. The storm surge – created when winds blow seawater up onto coastal areas -- was the biggest killer. Storm surges have been among Sandy's first effects on New York, New Jersey and Delaware.

“At least 1,500 persons lost their lives during Katrina and many of those deaths occurred directly, or indirectly, as a result of storm surge,” the National Hurricane Center says on its website.

Flash floods can also be a risk – not so much to people in homes, but to those out and about on foot and in cars. Even six inches of fast-moving water and pull a person down if they’re wading in it, and cars can be pulled into rivers or streams.

Live blog: Updates on Hurricane Sandy

When Hurricane Floyd hit North Carolina in 1999, dropping 20 inches of rain, most of those who died drowned when they were trapped in cars trying to navigate floodwaters, state health officials reported. Of the 52 people who died during and directly after Floyd, 24 died in cars, and seven, including five rescue workers, died trying to escape floodwaters by boat.

While people may worry about infectious diseases after hurricanes cause floods, they haven't historically been a major cause of death or illness. Health officials also issue detailed warnings about food poisoning -- a danger when power outages knock out refrigerators. But statistics don't indicate many deaths from foodborne illness after U.S. hurricanes.

Related news:

What food to save, throw out if you lose power

It's a wash for West Nile virus after Hurricane Isaac

Why people stay behind during hurricanes

For the first time in two decades, no one in California died from whooping cough last year, a public health victory that followed the deaths of 10 babies in 2010.

The state also cut the total number of whooping cough cases by two-thirds, from a high of nearly 9,000 in 2010 to less than 3,000 in 2011, officials announced Tuesday.

Dr. Gil Chavez, the California Department of Public Health epidemiologist and deputy director for infectious diseases, credited wider availability of vaccines, faster diagnosis, greater awareness and a new law that required pertussis booster shots for middle- and high-school kids.

“Looking at our data, we really identified that there were some gaps in the rates of vaccination of critical populations,” Chavez said.

The push depended on the cooperation of local health departments and health care providers working together to emphasize the need for vaccination against the infection.

Pertussis is a highly contagious bacterial illness spread by coughs and sneezes.

Efforts were targeted particularly toward families, caregivers and health care providers of babies younger than 6 months. Because they can’t be fully immunized until after that age, it’s important that everyone around the infants be protected against the disease, a process known as “cocooning," health experts say.

The number of whooping cough cases remained high in California, however, at nearly 3,000. The last time there were that many cases was in 2005. The last year in which no one died was 1991, when the state recorded just 249 cases of pertussis.

State officials are awaiting final figures that show how vaccination rates increased because of the efforts, Chavez said. The law requiring immunization of 7^th through 12-th graders will apply going forward to all students entering 7^th grade this year and in the future.

Officials at the Centers for Disease Control and Prevention applauded California's rapid response and vaccination efforts, said Alison Patti, a program manager. Pertussis is cyclical, so a drop in infections was expected as the disease made its way through the population. But efforts to accelerate and expand vaccination certainly helped.