title: Hospital versus home death: results from the Mexican Health and Aging Study.
abstract: BACKGROUND
  Characterizing where people die is needed to inform palliative care programs in Mexico.
  
  
  OBJECTIVE
  To determine whether access to health care influences the place of death of older Mexicans and examine the modifying effects of demographic and clinical characteristics.
  
  
  METHODS
  We analyzed 2001 baseline and 2003 follow-up data from the Mexican Health and Aging Study. Cases included adults who completed the baseline interview and died before the follow-up interview and for whom a proxy interview was obtained in 2003. The main outcome variable was the place of death (hospital vs. home). The predictors of the place of death were identified using logistic regression analysis.
  
  
  RESULTS
  The study group included 473 deceased patients; 52.9% died at home. Factors associated with hospital death were having spent at least one night in a hospital during the last year of life (odds ratio [OR]: 6.73; 95% confidence interval [CI]: 3.29, 13.78) and dying in a city other than the city of usual residence (OR: 4.68, 95% CI: 2.56, 8.57). Factors associated with home death were not having health care coverage (OR: 2.78, 95% CI: 1.34, 5.88), living in a city of less than 100,000 residents (OR: 2.44, 95% CI: 1.43, 4.17), and older age (OR: 1.03, 95% CI: 1.01, 1.05).
  
  
  CONCLUSIONS
  Older Mexicans with access to health care services were more likely to die in the hospital even after controlling for important clinical and demographic characteristics. Findings from the study may be used to plan the provision of accessible end-of-life hospital and home-based services.
authors.affiliation: Department of Critical Care Medicine, Center for Research on Minority Health, 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: Isabel
authors.initials: I
authors.lastname: Torres-Vigil
authors.forename: Horacio
authors.initials: H
authors.lastname: Tovalín-Ahumada
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Nates
mesh_terms: D000368:Aged; D003643:Death; D005260:Female; D018575:Home Care Services, Hospital-Based / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008800:Mexico / Q000453:epidemiology; D010166:Palliative Care / Q000706:statistics & numerical data*; D013727:Terminal Care / Q000706:statistics & numerical data*; D019452:Terminally Ill / Q000706:statistics & numerical data*