Place of Death and Associated Factors in 12 Latin American Countries: A Total Population Study Using Death Certificate Data

Abstract

Background: Little is known about place of death in Latin America although this data is crucial for health system planning. This paper aims to describe place of death and associated factors in Latin America and to identify factors that contribute to inter-country differences in place of death. Methods: We conducted a total population observational study using death certificates of the total annual decedent populations in 12 countries (Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, El Salvador, Guatemala, Mexico, Paraguay, Peru, and Uruguay). Data were analyzed regarding place of death and multivariable logistic regression was used to examine associated clinical and sociodemographic factors in each of the countries. Findings: Total study population was 3,001,640 deaths; 31·3% of deaths occurred at home, and 57·6% in hospitals. A strong variation was found between the countries with home deaths ranging from 20% (Brazil) to 65·5% (Guatemala) and hospital deaths from 24·8% (Guatemala) to 69·5% (Argentina). These differences between countries remained largely unchanged after controlling for sociodemographic factors and causes of death. The likelihood of dying at home was consistently higher with increasing age, for those living in a rural area, and for those with a lower educational level (except in Argentina). Interpretation: Most deaths in Latin America occur in hospitals, with a strong variation between countries. As clinical and sociodemographic factors included in this study did not explain country differences, other factors such as policy and healthcare system seem to have a crucial impact on where people die in Latin America. Funding Information: No funding was received in the course of this study. Declaration of Interests: We declare no competing interests. Ethics Approval Statement: The project was approved by the Ethics committee of RWTH Aachen University (EK 206/19).