Deaths of children occurring at home in six European countries.
OBJECTIVE
Until now there have been no population-based European data available regarding place of death of children. This study aimed to compare proportions of home death for all children and for children dying from complex chronic conditions (CCC) in six European countries and to investigate related socio-demographic and clinical factors.


METHODS
Data were collected from the death certificates of all deceased children aged 1-17 years in Belgium, the Netherlands, Norway, England, Wales (2003) and Italy (2002). Gender, cause and place of death (home vs. outside home) and socio-demographic factors (socio-economic status, degree of urbanization and number of hospital beds in the area) were included in the analyses. Data were analysed using frequencies and multivariate logistic regression.


RESULTS
In total 3328 deaths were included in the analyses; 1037 (31.2%) related to CCC. The proportion of home deaths varied between 19.6% in Italy and 28.6% in the Netherlands and was higher for children dying from CCC in all the countries studied, varying between 21.7% in Italy and 50% in the Netherlands. Among children dying from CCC, home death was more likely for cancer patients and those aged over 10 years. After controlling for potentially related clinical and socio-demographic factors, differences in the proportion of home deaths between countries remained significant, with higher proportions in Belgium and the Netherlands as compared with Italy.


CONCLUSIONS
Although home deaths comprise a substantial proportion of all deaths of children with CCCs, variation among disease categories and across countries suggest that considerable potential still exists for further improvements in facilitating end-of-life care in the home for those children and families who desire to be in this location.
Pousset
G
G
Bioethics Institute Ghent, Ghent University, Ghent, Belgium. geert.pousset@ugent.be
Bilsen
J
J
Cohen
J
J
Addington-Hall
J
J
Miccinesi
G
G
Onwuteaka-Philipsen
B
B
Kaasa
S
S
Mortier
F
F
Deliens
L
L
D000293:Adolescent; D001293:Attitude to Death; D002423:Cause of Death; D002648:Child; D046688:Child Mortality; D002675:Child, Preschool; D002908:Chronic Disease / Q000453:epidemiology; D003431:Cross-Cultural Comparison; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D013727:Terminal Care / Q000706:statistics & numerical data; D019452:Terminally Ill / Q000706:statistics & numerical data