Exploring factors and trends in place of death by cancer: A population-based study in Brazil.

Abstract

237 Background: Place of death serves as an indicator of the quality of end-of-life care. This study seeks to elucidate the place of deaths by cancer in Brazil, also identifying factors contributing to regional disparities in end-of-life settings. Methods: Using data obtained from the National Mortality Information System, this study extracted sociodemographic characteristics and the location of cancer deaths in Brazil from 2012 to 2021. The place of death was classified into hospital death, home death, and other settings (not shown). Results: A total of 2.165.643 deaths by cancer were included. Almost half of the cases were from Southeast (47.4%), while 22.0% were from Northeast, 19.0% from South and the minority from Central-west (6.5%) and North (5.0%) regions; remarkably, 73.3% of deaths occurred out of capitals. A downward trend was observed from 2012 to 2021 with a Relative Percent Difference (RPD) of -4,0. The frequency of deaths occurring at home in the Northeast region (26.6%) was found to be higher than the reference region, the Southeast (10.6%), RPD -22.2. Furthermore, Indigenous individuals showed a higher frequency of death at home (25.4%) compared to White ethnicity (14.2%), RPD -18.4. A clear inverse relation between in-hospital deaths and aging can be noted, as more at-home deaths are observed in the elderly (17.8%) compared to the young group (4.1%). Conclusions: Most cancer deaths in Brazil occur in hospitals. Death at home is related to pronounced regional differences, being higher in the North and Northeast, and may be related to advanced age, race and educational level.[Table: see text]