Which patients with cancer die at home? A study of six European countries using death certificate data.
OBJECTIVE
This study examines the proportion of cancer deaths occurring at home in six European countries in relation to illness and to demographic and health care factors.


METHODS
Death certificate data of all cancer-related deaths in 2002 in Italy and 2003 in Belgium, the Netherlands, Norway, England, and Wales (N = 238,216) were linked with regional health care and area statistics. Multivariate binomial logistic regressions were performed to examine factors associated with dying at home.


RESULTS
The percentage of all cancer deaths occurring at home was 12.8 in Norway, 22.1 in England, 22.7 in Wales, 27.9 in Belgium, 35.8 in Italy, and 45.4 in the Netherlands. Having solid cancers and being married increased the chances of dying at home in all countries. Being older and being a woman decreased the chances of dying at home, except in Italy where the opposite was the case. A higher educational attainment was associated with better chances of dying at home in Belgium, Italy, and Norway (countries where information on educational attainment was available). Better chances of dying at home were also associated with living in less urbanized areas in all countries but England. The number of hospital and care home beds seemed not to be universally strong predictors of dying at home.


CONCLUSIONS
There are large country differences in the proportion of patients with cancer dying at home, and these seem influenced by country-specific cultural, social, and health care factors. Alongside cross-national differences, country-specific aspects need to be considered in the development of policy strategies facilitating home death.
Cohen
Joachim
J
End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium. Joachim.Cohen@vub.ac.be
Houttekier
Dirk
D
Onwuteaka-Philipsen
Bregje
B
Miccinesi
Guido
G
Addington-Hall
Julia
J
Kaasa
Stein
S
Bilsen
Johan
J
Deliens
Luc
L
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003644:Death Certificates; D004522:Educational Status; D005060:Europe / Q000453:epidemiology; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality*; D012737:Sex Factors; D013727:Terminal Care / Q000706:statistics & numerical data*; D019452:Terminally Ill / Q000706:statistics & numerical data*; D014507:Urbanization; D055815:Young Adult