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Inequality in place-of-death among children: a Danish nationwide study

Abstract

To identify predictors for home death among children using socio-demographic factors and cause of death. It is a nationwide registry study. A cohort of children (1–17 years) who died between 1 January 2006 and 31 December 2016. It was set in Denmark, Europe. Predictors for home death were assessed: age, gender, diagnosis, region of residence, urbanicity, household income and immigrant status. Of 938 deceased children included, causes of death were solid tumours (17.3%), haematological cancers (8.5%) and non-cancerous conditions (74.2%). A total of 25% died at home. Compared to the lowest quartile, the groups with higher household income did not have a higher probability of dying at home (adjusted odds ratio (adj-OR) 0.8 (95% CI 0.5–1.2/1.3)). Dying of haematological cancers (adj-OR 0.3 (95% CI 0.2–0.7)) and non-cancerous conditions (adj-OR 0.5 (95% CI 0.3–0.7)) was associated with lower odds for home death compared to dying of solid tumours. However, being an immigrant was negatively associated with home death (adj-OR 0.6 (95% CI 0.4–0.9)). Moreover, a tendency was also found that being older, male, living outside the capital and in more urban areas were notable in relation to home death, however, not statistically significant.

Conclusions: The fact that household income was not associated with dying at home may be explained by the Danish tax-financed healthcare system. However, having haematological cancers, non-cancerous conditions or being an immigrant were associated with lower odds for home death. Cultural differences along with heterogeneous trajectories may partly explain these differences, which should be considered prospectively.

What is Known:
• Prior studies have shown disparities in place-of-death of terminally ill children with diagnosis, ethnicity and socio-economic position as key factors.
• Danish healthcare is tax-financed and in principle access to healthcare is equal; however, disparities have been found in the intensity of treatment of terminally ill children.
What is New:
• In a tax-financed, equal-access healthcare system, children died just as frequently at home in families with low as high household income.
• Disparities in home death were related to diagnosis and immigrant status.

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All authors declare that all data and materials as well as software application support their published claims and comply with field standards.

Abbreviations

CI:

Confidence interval

DRCD:

Danish National Register of Causes of Death

GP:

General practitioner

HI-EOL:

High-intensity treatment at end-of-life

MICE:

Multiple imputations with chained equations

OR:

Odds ratio

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Funding

This study was supported by grants from M.L. Jørgensen and Gunnar Hansens Fond, Dagmar Marshalls Fond and Kong Christian den Tiendes Fond. The funders had no role in study design, data collection and analyses, decision to publish or construction of the manuscript.

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Authors and Affiliations

Authors

Contributions

Ms Wolff conceptualised and designed the study and conducted the analyses. Ms Wolff and Dr Neergard drafted the initial manuscript. Dr Neergaard, Dr Christiansen, Prof Johnsen and Prof Schroeder conceptualised and designed the study and all authors reviewed and revised the manuscript. All authors have approved the final version of the manuscript and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Mette Asbjoern Neergaard.

Ethics declarations

Ethics approval

The study was reported to the Danish Data Protection Agency through Aarhus University (record no. 2016–051-000001/977), and all data were stored and managed at secure servers at Statistics Denmark. According to Danish law, registry-based studies do not require ethics approval.

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N/A

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N/A

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The authors declare no competing interests.

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Communicated by Peter de Winter

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Wolff, S.L., Christiansen, C.F., Johnsen, S.P. et al. Inequality in place-of-death among children: a Danish nationwide study. Eur J Pediatr 181, 609–617 (2022). https://doi.org/10.1007/s00431-021-04250-5

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  • DOI: https://doi.org/10.1007/s00431-021-04250-5

Keywords

  • Child
  • Youth
  • Paediatrics
  • End-of-life
  • Place-of-death
  • Denmark