Dying at home or in an institution using death certificates to explore the factors associated with place of death.
BACKGROUND
The knowledge of determinants of place of death is important for public health policy aimed at improving the quality of end-of-life care.


METHODS
We investigated the influence of clinical, socio-demographic, residential and health care system factors on the place of death, using data from all 55,759 deaths in 2001 in Flanders (Belgium), gathered via official death certificates and data from anonymously linked health care statistics. A multivariate logistic regression was used to examine the associated factors (home versus hospital as dependent categories).


RESULTS
Of all deaths in Flanders, 53.7% took place in hospital, 24.3% at home and 19.8% in a care home. The probability of home deaths varied by region, by rural or urban residence and by the hospital bed availability in the region and dying at home was less likely among those suffering from certain non-malignant chronic diseases, the less educated and those living alone.


CONCLUSIONS
Although most people wish to die at home, most deaths in Flanders (Belgium) in 2001 did not take place there. The clinical, socio-demographic and residential factors found to be associated with the place of death could serve as focal points for a policy to facilitate dying in the place of choice, including at home.
Cohen
Joachim
J
End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium. Joachim.Cohen@vub.ac.be
Bilsen
Johan
J
Hooft
Peter
P
Deboosere
Patrick
P
van der Wal
Gerrit
G
Deliens
Luc
L
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium; D003644:Death Certificates; D005260:Female; D006699:Home Care Services; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D013727:Terminal Care; D019452:Terminally Ill