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Place of death in the population dying from diseases indicative of palliative care need: a cross-national population-level study in 14 countries
  1. Lara Pivodic1,
  2. Koen Pardon1,
  3. Lucas Morin2,3,
  4. Julia Addington-Hall4,
  5. Guido Miccinesi5,
  6. Marylou Cardenas-Turanzas6,
  7. Bregje Onwuteaka-Philipsen7,
  8. Wayne Naylor8,
  9. Miguel Ruiz Ramos9,
  10. Lieve Van den Block1,
  11. Donna M Wilson10,
  12. Martin Loucka11,
  13. Agnes Csikos12,
  14. Yong Joo Rhee13,
  15. Joan Teno14,
  16. Luc Deliens1,15,
  17. Dirk Houttekier1,
  18. Joachim Cohen1
  19. on behalf of EURO IMPACT
  1. 1Department of Family Medicine & Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
  2. 2French National Observatory on End-of-Life Care, Paris, France
  3. 3Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
  4. 4Faculty of Health Sciences, University of Southampton, Hampshire, UK
  5. 5ISPO, Cancer Prevention and Research Institute, Florence, Italy
  6. 6The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
  7. 7EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
  8. 8Hospice Waikato, Hamilton, New Zealand
  9. 9Regional Ministry of Equality, Health and Social Policies in Andalusia, Seville, Spain
  10. 10Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
  11. 11Center for Palliative Care, Prague, Czech Republic
  12. 12University of Pécs Medical School, Pécs, Hungary
  13. 13Dongduk Women's University, Seoul, South Korea
  14. 14Brown University, School of Public Health, Providence, Rhode Island, USA
  15. 15Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
  1. Correspondence to Lara Pivodic, Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, Brussels 1090, Belgium; lara.pivodic{at}


Background Studying where people die across countries can serve as an evidence base for health policy on end-of-life care. This study describes the place of death of people who died from diseases indicative of palliative care need in 14 countries, the association of place of death with cause of death, sociodemographic and healthcare availability characteristics in each country and the extent to which these characteristics explain country differences in the place of death.

Methods Death certificate data for all deaths in 2008 (age ≥1 year) in Belgium, Canada, the Czech Republic, England, France, Hungary, Italy, Mexico, the Netherlands, New Zealand, South Korea, Spain (Andalusia), the USA and Wales caused by cancer, heart/renal/liver failure, chronic obstructive pulmonary disease, diseases of the nervous system or HIV/AIDS were linked with national or regional healthcare statistics (N=2 220 997).

Results 13% (Canada) to 53% (Mexico) of people died at home and 25% (the Netherlands) to 85% (South Korea) died in hospital. The strength and direction of associations between home death and cause of death, sociodemographic and healthcare availability factors differed between countries. Differences between countries in home versus hospital death were only partly explained by differences in these factors.

Conclusions The large differences between countries in and beyond Europe in the place of death of people in potential need of palliative care are not entirely attributable to sociodemographic characteristics, cause of death or availability of healthcare resources, which suggests that countries’ palliative and end-of-life care policies may influence where people die.


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