Abstract
Background: Location of death has been used to examine an indicator for good death. This study aims to examine location of death among patients with three major cancers (gastric, liver, and lung) and other factors associated with location of death in South Korea. Methods: We selected the medical and pharmacy claims data for health services and location of death among the 42,596 decedents with cancer (lung 16,632, liver 15,872, gastric 10,092) from 2009 to 2013. We used logistic regressions to identify factors associated with home death. Outcome measures are locations of death (hospital, outpatient clinics or emergency room and home). Results: Only 8.9% died at home whereas 46.5% died in hospital as inpatients. Patients with more than one comorbid cancer or receivers for any supportive care were significantly more likely to die in hospital. Female and younger than 55 years old liver cancer patients were associated with home death. Patients living in metropolitan area, or paying more insurance premium, or being public aid beneficiaries, were associated with home death. Conclusions: The supportive care service use prior to death was significantly associated with increasing odds to hospital death. Being older than 75, or having multiple cancers was significant factors associated with hospital death, whereas living in metropolitan area, lower income or emergency visit were significant factors with home death. These findings are opposite to what is found, as the palliative care and hospice is predominantly hospital-centered. The findings emphasize a need to available end-of-life care in community for dying patients.
Highlights
A death at home has been considered as a significant outcome and a “good death” in a large body of research in end of life care [1] [2] [3] [4] [5] due to better quality of care [2] [6] and autonomy [3] [5] [6]
Most of patients with any cancer in South Korea are more likely to die in hospital (87.2%) which is surprisingly greater than other countries [18]
This study examined the location of death among the major three cancer patients using medical claims dataset and examined the factors associated with home death
Summary
A death at home has been considered as a significant outcome and a “good death” in a large body of research in end of life care [1] [2] [3] [4] [5] due to better quality of care [2] [6] and autonomy [3] [5] [6]. If the hospital-focused development of palliative care in South Korea is an explanation for the large proportion dying in hospital [19], this could imply that those cancer patients get a supportive type of care at the end-of-life, which can include use of services such as hospice and palliative care and die so in the hospital rather than at home [20]. Being older than 75, or having multiple cancers was significant factors associated with hospital death, whereas living in metropolitan area, lower income or emergency visit were significant factors with home death. These findings are opposite to what is found, as the palliative care and hospice is predominantly hospital-centered. The findings emphasize a need to available end-of-life care in community for dying patients
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