Where a cancer patient dies: the effect of rural residency.
BACKGROUND
Surveys indicate 50% to 80% of cancer patients would choose to die at home if possible, although far fewer actually do. In Nova Scotia (NS), cancer deaths occurring out-of-hospital increased from 19.8% in 1992 to 30.2% in 1997. The impact of rural residency on this trend has not been studied.


OBJECTIVE
To determine the association between dying of cancer in a rural locale and the likelihood of it being an out-of-hospital death.


METHODS
Secondary analysis of linked population-based administrative health data files. Subjects were all Nova Scotians who died of cancer from 1992 to 1997. Measures included location of death, dichotomized as a hospital death or an out-of-hospital death; and urban-rural residency, using an enumeration area urban-rural indicator created from postal code information adjusted for individual characteristics.


RESULTS
Of the 13,652 total cancer deaths, 6171 occurred in rural NS, of whichl 1471 (23.8%) died out-of-hospital. Out-of-hospital deaths in rural NS increased from 16.2% in 1992 to just over 27% in 1997. Compared with urban cancer patients, the adjusted odds of an out-of-hospital death in rural NS was lower (adjusted odds ratio, 0.87; 95% confidence interval, 0.79-0.95).


CONCLUSIONS
There was an increasing trend during the 1990s for cancer patients to die out-of-hospital. Compared with their urban counterparts, patients in rural areas were less likely to do so. Those with cancer living in the rural setting who wish to die at home may face unique challenges.
Burge
Frederick
F
Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia. fred.burge@dal.ca
Lawson
Beverley
B
Johnston
Grace
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019352:Censuses; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality*; D009674:Nova Scotia / Q000453:epidemiology; D016017:Odds Ratio; D012111:Residence Characteristics / Q000145:classification*; D012189:Retrospective Studies; D012424:Rural Population / Q000706:statistics & numerical data*; D013727:Terminal Care / Q000458:organization & administration*; D014505:Urban Population / Q000706:statistics & numerical data*