Abstract
Background
The majority of people dying from chronic diseases prefer to die at home, yet many die in hospitals. Cross-national population-level studies on the place of death are scarce although they can provide important evidence to guide the development and evaluation of public health policies for end-of-life care. We compared the place of death of populations potentially benefiting from palliative care in nine European and five non-European countries, and examined to what extent country-variation in the place of death is related to socio-demographic characteristics, cause of death and healthcare supply measures.
Methods
Death certificate data for all deaths of 2008 in Belgium, England, Wales, France, Italy, Mexico, Netherlands, New Zealand, Canada, Czech Republic, Hungary, South Korea, USA and Spain (Andalusia) with an underlying cause of death corresponding to the minimal palliative care subset (Rosenwax et al. 2005) were linked with regional healthcare statistics (N = 2,220,997). The main outcome measure was the place of death as registered on the death certificate. As the entire population was studied it was not needed to compute confidence intervals.
Results
People in potential need of palliative care died at home in 13% (Canada) to 53% (Mexico) of cases, in hospital in 25% (Netherlands) to 85% (South Korea) of cases, and in a long-term care institution in 1% (South Korea) to 35% (Netherlands) of cases. The large differences across countries in the proportion of people dying at home rather than in hospital were only partly explained by differences in age, sex, marital status, cause of death, and the density of hospital beds, long-term care beds and general practitioners per region of residence of the deceased.
Conclusions
Country differences in place of death in a population potentially benefiting from palliative care persisted after adjustment for differences in clinical and socio-demographic factors and measures of healthcare supply. The variation between countries may be attributable to different palliative and end-of-life care policies and practices.
The majority of people dying from chronic diseases prefer to die at home, yet many die in hospitals. Cross-national population-level studies on the place of death are scarce although they can provide important evidence to guide the development and evaluation of public health policies for end-of-life care. We compared the place of death of populations potentially benefiting from palliative care in nine European and five non-European countries, and examined to what extent country-variation in the place of death is related to socio-demographic characteristics, cause of death and healthcare supply measures.
Methods
Death certificate data for all deaths of 2008 in Belgium, England, Wales, France, Italy, Mexico, Netherlands, New Zealand, Canada, Czech Republic, Hungary, South Korea, USA and Spain (Andalusia) with an underlying cause of death corresponding to the minimal palliative care subset (Rosenwax et al. 2005) were linked with regional healthcare statistics (N = 2,220,997). The main outcome measure was the place of death as registered on the death certificate. As the entire population was studied it was not needed to compute confidence intervals.
Results
People in potential need of palliative care died at home in 13% (Canada) to 53% (Mexico) of cases, in hospital in 25% (Netherlands) to 85% (South Korea) of cases, and in a long-term care institution in 1% (South Korea) to 35% (Netherlands) of cases. The large differences across countries in the proportion of people dying at home rather than in hospital were only partly explained by differences in age, sex, marital status, cause of death, and the density of hospital beds, long-term care beds and general practitioners per region of residence of the deceased.
Conclusions
Country differences in place of death in a population potentially benefiting from palliative care persisted after adjustment for differences in clinical and socio-demographic factors and measures of healthcare supply. The variation between countries may be attributable to different palliative and end-of-life care policies and practices.
| Original language | English |
|---|---|
| Pages (from-to) | 11-12 |
| Journal | European Journal of Public Health |
| Volume | 24 |
| Issue number | suppl 2 |
| Publication status | Published - 31 Oct 2014 |
| Event | Unknown - Duration: 31 Oct 2014 → … |
Keywords
- palliative care
- end of life care
- place of death
- death certificates