title: Using death certificate data to study place of death in 9 European countries: opportunities and weaknesses.
abstract: BACKGROUND
  Systematic and reliable epidemiological information at population level, preferably cross-national, is needed for an adequate planning of (end-of-life) health care policies, e.g. concerning place of death, but is currently lacking. This study illustrates opportunities and weaknesses of death certificate data to provide such information on place of death and associated factors in nine European countries (seven entire countries and five regions).
  
  
  METHODS
  We investigated the possibility and modality of all partners in this international comparative study (BE, DK, IT, NL, NO, SE, UK) to negotiate a dataset containing all deaths of one year with their national/regional administration of mortality statistics, and analysed the availability of information about place of death as well as a number of clinical, socio-demographic, residential and healthcare system factors.
  
  
  RESULTS
  All countries negotiated a dataset, but rules, procedures, and cost price to get the data varied strongly between countries. In total, about 1.1 million deaths were included. For four of the nine countries not all desired categories for place of death were available. Most desired clinical and socio-demographic information was available, be it sometimes via linkages with other population databases. Healthcare system factors could be made available by linking existing healthcare statistics to the residence of the deceased.
  
  
  CONCLUSIONS
  Death certificate data provide information on place of death and on possibly associated factors and confounders in all studied countries. Hence, death certificate data provide a unique opportunity for cross-national studying and monitoring of place of death. However, modifications of certain aspects of death certificate registration and rules of data-protection are perhaps required to make international monitoring of place of death more feasible and accurate.
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium. jcohen@vub.ac.be
authors.forename: Joachim
authors.initials: J
authors.lastname: Cohen
authors.forename: Johan
authors.initials: J
authors.lastname: Bilsen
authors.forename: Guido
authors.initials: G
authors.lastname: Miccinesi
authors.forename: Rurik
authors.initials: R
authors.lastname: Löfmark
authors.forename: Julia
authors.initials: J
authors.lastname: Addington-Hall
authors.forename: Stein
authors.initials: S
authors.lastname: Kaasa
authors.forename: Michael
authors.initials: M
authors.lastname: Norup
authors.forename: Gerrit
authors.initials: G
authors.lastname: van der Wal
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D003431:Cross-Cultural Comparison; D016208:Databases, Factual; D003644:Death Certificates; D005060:Europe / Q000453:epidemiology; D005260:Female; D006291:Health Policy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009026:Mortality; D040442:Public Health Informatics; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D013727:Terminal Care