title: The place of death of children with cancer in the metropolitan areas of Mexico.
abstract: We sought to understand the factors associated with the place of death of children with cancer in metropolitan Mexico by carrying a retrospective review of death certificates. We selected deaths occurring in the metropolitan areas and included a total of 1948 cases with cancer as underlying cause of death. Cases were registered from 2002 to 2004, age < 18 years, and with complete data on socio-demographics. The study outcome was death occurring in a medical unit or home. Eighty-five percent of the cases died in hospitals. Multivariate analysis indicated patients diagnosed with leukemia or lymphomas were 2.5 times more likely to die in hospitals than patients diagnosed with other cancers (p < 0.001). Patients < 1-year old were 2.9 times more likely to die in hospitals than those older than 15 (p = 0.03). Higher average annual family income per county of residency was significantly associated with in-hospital death (p=0.02). Compared with patients who died at home, in-hospital deaths were more likely to occur if cases were transient residents of the study areas (OR 79.7 95% CI 24.9, 255.0, (p < 0.001) and if death occurred in the areas of Monterrey or Guadalajara compared to the Valley of Mexico (OR 1.60 95% CI 1.12, 2.29, (p = 0.01] and (OR 4.01 95% CI 2.24, 7.21, (p < 0.001), respectively. By highlighting the characteristics of children with cancer dying at home or in hospitals is crucial to allocating palliative care services. Children of older age, lower socioeconomic status, and those diagnosed with non-hematological cancers should be the target of home-based interventions.
authors.affiliation: Department of Critical Care Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030-4009, USA. mcardena@mdanderson.org
authors.forename: Marylou
authors.initials: M
authors.lastname: Cárdenas-Turanzas
authors.forename: Horacio
authors.initials: H
authors.lastname: Tovalín-Ahumada
authors.forename: María Teresa
authors.initials: MT
authors.lastname: Carrillo
authors.forename: Sandra
authors.initials: S
authors.lastname: Paéz-Aguirre
authors.forename: Linda
authors.initials: L
authors.lastname: Elting
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003644:Death Certificates; D005260:Female; D006699:Home Care Services; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008800:Mexico / Q000453:epidemiology; D009369:Neoplasms / Q000401:mortality*; D017060:Patient Satisfaction; D012189:Retrospective Studies; D014505:Urban Population