Article Text

Download PDFPDF
Trends in place of death in a small developing country: a population-level study using death certificate data
  1. Nicholas Jennings1,2,
  2. Kenneth Chambaere1,
  3. Luc Deliens1,3,
  4. Joachim Cohen1
  1. 1End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
  2. 2Bioethics Department, St George’s University School of Medicine, St George’s, Grenada
  3. 3Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
  1. Correspondence to Nicholas Jennings, End-of-life Care Research Group, Department of Medical Sociology and Health Sciences, Faculty of Medicine, Vrije Universiteit Brussel, Brussels B-1090, Belgium; nicholas.jennings{at}


Background Valuable information for planning future end-of-life care (EOLC) services and care facilities can be gained by studying trends in place of death (POD). Scarce data exist on the POD in small developing countries. This study aims to examine shifts in the POD of all persons dying between 1999 and 2010 in Trinidad and Tobago, to draw conclusions about changes in the distribution of POD over time and the possible implications for EOLC practice and policy.

Methods A population-level analysis of routinely collected death certificate data of the most recent available fully coded years at the time of the study—1999 to 2010. Observed proportions for the POD of all deaths were standardised according to the age, sex and cause of death distribution in 1999. Trends for a subgroup of persons who died from causes indicative of a palliative care (PC) need were also examined.

Results The proportion of deaths in government hospitals increased from 48.9% to 55.4% and decreased from 38.7% to 29.7% at private homes. There was little variation between observed and standardised rates. The decrease in home deaths was stronger when the PC subcategory was considered, most notably from cancer.

Conclusion Internationally, the proportion of deaths at institutions is increasing. A national strategy on palliative and EOLC is needed to facilitate the increasing number of people who seek EOLC at government hospitals in Trinidad and Tobago, including an investigation into the reasons for the trend. Alternatives to accommodate out-of-hospital deaths can be considered.

  • Place of death
  • trend
  • end-of-life care
  • hospital
  • developing country
  • Caribbean

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors Study design: Nicholas Jennings, Kenneth Chambaere, Luc Deliens and Joachim Cohen; analysis: NJ, KC, and JC; manuscript preparation: all authors.

  • Funding Funded by the Research Council of the Vrije Universiteit Brussel: Strategic Research Programs (SRP 4).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Not required.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. The Central Statistical Office, the relevant agency responsible for maintaining the Trinidad and Tobago national death registry, provided access to archived de-identified datasets. The data of this study are with the first author and are available upon request.

  • Provenance and peer review Not commissioned; externally peer reviewed.