Determinants of the place of death in the Brussels metropolitan region

Where people die is considered an indicator of quality of death, but also has implications for healthcare costs and the organisation of end-of-life care. Advancing urbanisation, combined with social fragmentation, poor social conditions, and concentration of inpatient care in large cities make it relevant to study place of death in a metropolitan context. The objective of this article is to examine determinants of place of death (home, care home, hospital) in Brussels metropolitan region (Belgium) for patients suffering from chronic diseases eligible for palliative care. Using death certificate data, we described place of death and associated factors for all deaths after chronic diseases in 2003 in Brussels (N=3672). Of all chronically ill patients 15,1% died at home, 63,0% in hospital, and 21,6% in a care home. Of those residing in care homes, 23,8% died in hospital. Non-cancer patients and residents of districts with higher socio-economic status had more chance of dying at home or in a care home if they resided in one. Home death was also more likely for patients not living alone. Care home death was more likely with increasing age. Compared to other parts of Belgium and other big cities worldwide, in Brussels few patients eligible for palliative care died at home. Both the overall low proportion of people dying in familiar surroundings as well as the inequality between different districts in Brussels imply that a health policy aiming at facilitating dying in the place of choice might also need to develop specific approaches for metropolitan cities.