Metropolitan Versus Nonmetropolitan Variation in Place of Death in Belgium, the Netherlands and England

Introduction

Place of death is considered an indicator of good end-of-life care, with home death preferred by most terminally ill patients. Previous research suggests substantially more hospital death and less home death in the metropolitan versus non-metropolitan regions of Europe. This study therefore examines metropolitan versus nonmetropolitan variation in place of death in Belgium, the Netherlands and England.

Methods and materials

Death certificate data of all deaths in 2003 were linked to census data. Place of death of those dying of 7 conditions likely to benefit from palliative care (cancer, heart/renal/liver failure, respiratory/neurodegenerative disease, HIV/AIDs) living in 6 English, 3 Dutch and 2 Belgian metropolitan regions was compared to that of nonmetropolitan residents. When examining differences in place of death (home vs. hospital; care home vs. hospital), multivariate analysis was used to control for possible confounders: cause of death, sex, age, income, social support, and available hospital and care home beds.

Results

Those living in metropolitan regions less often died at home and more often in hospitals, compared to nonmetropolitan patients. In Belgium and the Netherlands they also more often died in care homes. Multivariate logistic regression analyses showed that, even after controlling for possible confounders, those in nonmetropolitan regions were more likely to die at home and less likely to die in hospitals than those in metropolitan regions (OR: Eng:1.26; NL:1.49; B:1.74). In England, those in nonmetropolitan regions were more likely to die in a care home and less likely to die in hospital than metropolitan residents (OR: 1.34).

Conclusion

Dying in Europe's metropolitan regions is less likely to occur at home and more likely to occur in hospital than in nonmetropolitan regions. This inequality could point at different end-of-life care in metropolitan regions, and suggests the need for a metropolitan approach to end-of-life care in all care settings.