Abstract
BackgroundDying at home is the most frequent preference of patients with advanced chronic conditions, their caregivers, and the general population. However, most deaths continue to occur in hospitals. The objective of this study was to analyse the socioeconomic inequalities in the place of death in urban areas of Mediterranean cities during the period 2010–2015, and to assess if such inequalities are related to palliative or non-palliative conditions.MethodsThis is a cross-sectional study of the population aged 15 years or over. The response variable was the place of death (home, hospital, residential care). The explanatory variables were: sex, age, marital status, country of birth, basic cause of death coded according to the International Classification of Diseases, 10th revision, and the deprivation level for each census tract based on a deprivation index calculated using 5 socioeconomic indicators. Multinomial logistic regression models were adjusted in order to analyse the association between the place of death and the explanatory variables.ResultsWe analysed a total of 60,748 deaths, 58.5% occurred in hospitals, 32.4% at home, and 9.1% in residential care. Death in hospital was 80% more frequent than at home while death in a nursing home was more than 70% lower than at home. All the variables considered were significantly associated with the place of death, except country of birth, which was not significantly associated with death in residential care. In hospital, the deprivation level of the census tract presented a significant association (p < 0.05) so that the probability of death in hospital vs. home increased as the deprivation level increased. The deprivation level was also significantly associated with death in residential care, but there was no clear trend, showing a more complex association pattern. No significant interaction for deprivation level with cause of death (palliative, not palliative) was detected.ConclusionsThe probability of dying in hospital, as compared to dying at home, increases as the socioeconomic deprivation of the urban area of residence rises, both for palliative and non-palliative causes. Further qualitative research is required to explore the needs and preferences of low-income families who have a terminally-ill family member and, in particular, their attitudes towards home-based and hospital-based death.
Highlights
Dying at home is the most frequent preference of patients with advanced chronic conditions, their caregivers, and the general population
876 (1.3%) could not be assigned to their census tract of residence due to the unavailability of a valid residence address or that it did not belong to the city
The percentage of death in hospitals ranged from a minimum of 47.3% in people aged 85 and over to a maximum of 81.2% in people aged 15 to 44 years. It went from 16.5% in people aged 15–44 to 39.8% in people residing in the The most socioeconomically favoured areas (DL1) areas
Summary
Dying at home is the most frequent preference of patients with advanced chronic conditions, their caregivers, and the general population. Dying at home is the most frequent preference of patients with advanced chronic diseases [3,4,5,6], their caregivers [4], and the general population [4], and so it has become an indicator of the quality of palliative care [7]. Place of death predictors are traditionally grouped into three categories: disease-related factors, individual factors, and environmental factors [2]. The relationship with disease factors, like the diagnosis of the patient’s pathology [6,7,8, 12,13,14] and environmental factors such as the availability of family support and home care resources [15,16,17], as well as other more generally related to or derived from local laws or health policies, has been examined [6, 18]
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