Journal of Community Health

, Volume 12, Issue 1, pp 40–55 | Cite as

Factors affecting place of death in Washington State, 1968–1981

  • Lincoln Polissar
  • Richard K. Severson
  • Norman K. Brown


A study was carried out to determine factors affecting place of death (home, hospital, nursing home or “other places”) among all 426,115 resident deaths in Washington State during 1968–1981, using death certificate information. Sixteen percent of deaths occurred at home, 74% in institutions (51% in hospitals, 23% in nursing homes) and 9% at “other places.” Age, marital status and cause of death all strongly affect place of death. Further, the effect of each factor was strongly dependent on the others. Sex had no effect on place of death after controlling for other factors. Elderly people died relatively more frequently in nursing homes, infants and middle aged people in hospitals and young adults in “other places.” The frequency of deaths at home was quite constant by age. Hospitals were the most common place of death following both vascular disease (including heart attack) and neoplasms, and nursing homes were the most common place of death following cerebrovascular disease (including “stroke”). Race, socioeconomic status and urban or rural residents affected the place of death only slightly or not at all. The place of death pattern changed little during the time period 1968–1981, except for a slight increase in frequency of home deaths and a corresponding decrease in the frequency of deaths in other places.

Among cancer patients, the likelihood of death at home was positively associated with longer periods of survival after diagnosis. Cancer patients of hospitals serving targeted populations, such as veterans, were relatively more likely to die in a hospital and less likely to die in a nursing home compared to other cancer patients, suggesting that the “targeted” hospitals are sometimes serving a nursing home function. There was a marked difference in the terminal cancer caseload by hospital. The number of cancer deaths per cancer diagnosis varied widely across hospitals (0.1 to 1.6) and was unrelated to size of the hospital or level of services offered.

Intervention aimed at affecting place of death, such as increasing the number of deaths at home, will need to take account of the joint effect of age, marital status and disease.


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  1. 1.
    Lerner, M: When, why and where people die. In OG Brim, HE Freeman, S Levine and NA Scotch (Eds.)The Dying Patient. New York: Russell Sage Foundation, 1970.Google Scholar
  2. 2.
    Vicker, RL, The hospice movement in the United States.Long Term Care and Health Services Administratio 3:253–283, 1979.Google Scholar
  3. 3.
    Callan, JP, The hospice movement.JAMA 241:600, 1979.Google Scholar
  4. 4.
    Leone, LA, The concept of hospice.CA 32: 141–143, 1982.Google Scholar
  5. 5.
    Robinson, BE, Hospice (letter).CA 33:60, 1983.Google Scholar
  6. 6.
    Leone, LA, Hospice (letter).CA 33:191–192, 1983.Google Scholar
  7. 7.
    Cartwright A, Hockey L, Anderson JL:Life Before Death. Boston: Routledge & Kegan Paul, 1973.Google Scholar
  8. 8.
    Katz BP, Zdeb MS, Therriault GD, Where people die.Public Health Rep 94:522–527, 1979.Google Scholar
  9. 9.
    McCusker J, Where cancer patients die. An epidemilogic study.Public Health Rep 98:170–176, 1983.Google Scholar
  10. 10.
    Flynn, A and Stewart, D, Where do cancer patients die?J of Community Health, 5:126–130, 1979.Google Scholar
  11. 11.
    Halper, T, On death, dying and terminality: Today, yesterday and tomorrow.J Health, Polit, Policy Law 4:11–29, 1979.Google Scholar
  12. 12.
    Kassakian MG, Bailey LR, Rinker M, Stewart CA and Yates JW, The cost and quality of dying: A comparison of home and hospital.Nurse Pract 4:18–19, 22–23, 1979.Google Scholar
  13. 13.
    Dempsy D:The Way We Die: An Investigation on Death and Dying in America. New York: MacMillan, 1975.Google Scholar
  14. 14.
    Amado A, Cronk BA, Mileo R. Cost of terminal care: Home hospice vs. hospital.Nurs Outlook 27:522–526, 1979.Google Scholar
  15. 15.
    Bloom, BS and Kissick, PD, Home and hospital cost of terminal illness.Med Care 18:560–564. 1980.Google Scholar
  16. 16.
    Krant, MJ, The hospice movement.New Engl 299:546–549, 1978.Google Scholar
  17. 17.
    Krakoff, IH. The case for active treatment in patients with advanced cancer: Not everyone needs a hospice.CA 29:108–111, 1979.Google Scholar
  18. 18.
    Hinton, J, Comparison of places and policies for terminal care.Lancet 1:29–32, 1979.Google Scholar
  19. 19.
    Sampson, WI, Dying at home.JAMA 238:2405–2406, 1977.Google Scholar
  20. 20.
    Smith, CA and Hill, PDH, Grieving responses: A comparison after home or hospital care.NZ Med J 88:393–395, 1978.Google Scholar
  21. 21.
    Soukop, M and Calman, KC, Cancer patients: Where do they die—an analysis.Practitioner 219:883–888, 1977.Google Scholar
  22. 22.
    Walter, NT, Continuing care of the cancer patient as a social engineering problem.Cancer Res 39:2859–2862, 1979.Google Scholar
  23. 23.
    Zimmerman, JM, Experience with a hospice-care program for the terminally ill.Ann Surg 189:683–690, 1979.Google Scholar
  24. 24.
    1980 U.S. Census Bureau publication #PC80-1-B49. General Population Characteristics for Washington State. Issued August, 1982.Google Scholar
  25. 25.
    Surveillance, Epidemiology, End Results (SEER): Incidence and mortality data: 1973–1977. NCI Monograph 57. Bethesda, MD, 1981.Google Scholar
  26. 26.
    International Classification of Diseases. 1965 Revision, World Health Organization, 1967.Google Scholar
  27. 27.
    International Classification of Diseases, 1975 Revision, World Health Organization, 1977.Google Scholar

Copyright information

© Human Sciences Press 1987

Authors and Affiliations

  • Lincoln Polissar
  • Richard K. Severson
  • Norman K. Brown

There are no affiliations available

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