Where do people die? An international comparison of the percentage of deaths occurring in hospital and residential aged care settings in 45 populations, using published and available statistics

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Abstract

Objective

Place of death, specifically the percentage who die in hospital or residential aged care, is largely unreported. This paper presents a cross-national comparison of location of death information from published reports and available data.

Methods

Reports of deaths occurring in hospitals, residential aged care facilities, and other locations for periods since 2001 were compiled.

Results

Over 16 million deaths are reported in 45 populations. Half reported 54 % or more of all deaths occurred in hospitals, ranging from Japan (78 %) to China (20 %). Of 21 populations reporting deaths of older people, a median of 18 % died in residential aged care, with percentages doubling with each 10-year increase in age, and 40 % higher among women.

Conclusions

This place of death study includes more populations than any other known. In many populations, residential aged care was an important site of death for older people, indicating the need to optimise models of end-of-life care in this setting. For many countries, more standardised reporting of place of death would inform policies and planning of services to support end-of-life care.

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Acknowledgments

We are extremely appreciative to the generous and helpful staffs of official information departments and ministries who have cooperated in providing information in emails, tables and online databases. We also acknowledge academics that assisted in sourcing data, including Dr. Silmara Gusso at the University of Auckland, New Zealand, and Dr. Heidy Leiva, Rancagua Regional Hospital, Chile. With one exception, all data were obtained without charge. We are also particularly grateful to Ann Peut also at AIHW, Canberra, who provided very valuable comments and assistance on several drafts of this paper. The Freemasons’ Department of Geriatric Medicine at the University of Auckland is supported by longstanding endowments and grants from Freemasons New Zealand and the Freemasons’ Roskill Foundation. Joanna Broad’s appointment is supported by grant 10/373 from the Health Research Council of New Zealand.

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Correspondence to Joanna B. Broad.

Appendix: Sources of population data

Appendix: Sources of population data

 

  Population and years reported Total number of deaths in period Number of deaths in people aged 65+ years (if stated) Restrictions Source of data: paper = academic paper, report = published report, database = access to electronic database, by request = table/data provided on request Data source or reference
1 Albania 2009 15,662   By request INSTAT (Instituti I Statisitkave) (2010)
2 Australia 2005 131,595 104,443 By request ABS (Australian Bureau of Statistics) (2010), AIHW (Australian Institute of Health and Welfare) (2009, 2011)
3 Austria 2009–10 154,580 127,289 By request Q: Statistick Austria (2011)
4 Belgium (Flanders) 2003 57,156   Paper Cohen et al. (2006)
5 Belgium (Flanders) 2001 55,759 46,271 Paper Cohen et al. (2008)
6 Belgium 2005–07 195,612   Aged 1 year or older Paper Houttekier et al. (2010)
7 Botswana 2005–06 18,869   Non-traumatic deaths only Paper Lazenby et al. (2010)
8 Brazil 2009 1,083,399   Database IBGE (Brazilian Institute of Geography and Statistics) (2010)
9 Canada 2004 171,094   Paper Wilson et al. (2009)
10 Chile 2007–09 275,133   By request DEIS, Ministry of Health (2011)
11 China 2004–05 868,484   Surveillance of 158 counties Report Chen (2008)
12 Croatia 2009 52,414 41,363 By request Croatian National Institute of Public Health (2011)
13 Cyprus 2007–09 15,757 12,678 By request Cyprus Ministry of Health (2011)
14 Czech Republic 2009 107,421 81,835 Database Czech Statistical Office (2011)
15 England and Wales 2008 509,090 421,074 Report National End-of-Life Care Programme (2010b)
16 England 2005–07 474,719 392,785 Database UK Statistics Authority (2009)
17 England 2007–09 Not stated   Database National End-of-Life Care Programme (2010a)
18 Estonia 2008–10 28,708   By request Ministry of Social Affairs of Estonia (2011)
19 France 2005–06 1,043,949 833,366 Database INSEE (Institut National de la Statistique et des Études Économiques) (2010, 2011)
20 Iceland 2007–09 5,932 4,875 By request Hagstofa Íslands | Statistics Iceland (2011)
21 Ireland 2000–10 318,184 248,016 By request CSO (Central Statistics Office) (2010)
22 Japan 2007–09 3,392,606   Database National Statistics Center (2010)
23 Korea 2009 246,942 169,902 Database Statistics Korea (2010)
24 Lithuania 2010 42,120   By request Institute of Hygiene, Lithuania (2011)
25 Malta 2001–10 31,294 25,050 By request Department of Health Information and Research, Malta (2011)
26 Netherlands 2003 141,936   Paper Cohen et al. (2008)
27 New Zealand 2003–07 140,836 140,836 By request Ministry of Health (2011)
28 Norway 2009 41,342   Database Statistisk sentralbyrå | Statistics Norway (2010)
29 Portugal (15+ years) 2008 98,840   Aged over 15 years Report Machado et al. (2010)
30 Scotland 2003 58,473   Paper Cohen et al. (2008)
31 Serbia 2006–09 412,400   Database Statistical Office of the Republic of Serbia (2010)
32 Slovenia 2005–09 92,647   By request Health Data Centre: National Institute of Public Health (2011)
33 South Africa 2005 591,213   Database Statistics South Africa (2005)
34 Spain (Andulasia) 2009 31,463   Paper Ruiz-Ramos et al. (2011)
35 Sweden 2002 95,064   Paper Cohen et al. (2008)
36 Switzerland (German) 2001 3,358   Aged over 1 year Paper Fischer et al. (2004)
37 Taiwan 2008 142,283   Database Taiwan (2008)
38 USA 2003 2,452,154 1,806,070 Database CDC (Centre for Disease Control) (2006)
39 USA 2005 2,452,506 1,790,062 Database CDC (Centre for Disease Control) (2008)
40 Wales 2003 33,810   Paper Cohen et al. (2008)
41 Canada (Manitoba) 2000 7,678 Aged over 65 years Paper Menec et al. (2007)
42 Canada (Ontario) 2002 58,689 Aged over 66 years Paper Motiwala et al. (2006)
43 Japan (Kyushu) 2000–04 50,857 Aged over 65 years Paper Hashimoto et al. (2010)
44 Singapore 2006 10,399 Aged over 65 years Paper Beng et al. (2009)
45 Wales 2001 27,532 Aged over 65 years Paper Ahmad and O’Mahony (2005)

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Broad, J.B., Gott, M., Kim, H. et al. Where do people die? An international comparison of the percentage of deaths occurring in hospital and residential aged care settings in 45 populations, using published and available statistics. Int J Public Health 58, 257–267 (2013). https://doi.org/10.1007/s00038-012-0394-5

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Keywords

  • Location of death
  • End-of-life care
  • Health services for the aged
  • Cross-national research
  • Palliative care
  • Service utilisation
  • Epidemiology
  • Health services research