title: Factors influencing place of death in Germany.
abstract: BACKGROUND
  Knowledge about factors influencing the place of death may be very useful for the planning of public health strategies to improve the situation of terminally ill patients.
  
  
  OBJECTIVE
  The aim of our study was to determine where people died in the German federal state of Rhineland-Palatinate in 2008. We further wanted to detect which factors had an influence on the place of death.
  
  
  METHODS
  Our cross-sectional survey was based on a random sample of 5000 inhabitants of Rhineland-Palatinate who had died between May 25, 2008 and August 24, 2008. Relatives of these randomly drawn deceased persons were interviewed by means of a written survey.
  
  
  RESULTS
  After removing duplicates, 4967 questionnaires were sent out. In total, 3832 questionnaires were delivered and 1378 completed, leading to a response rate of 36.0%. Of this group, 38.2% of the deceased died at home, 39.3% in a hospital, 13.4% in a nursing home, 7.5% in a palliative care facility, and 1.6% elsewhere. Suffering from cancer (adjusted odds ratio [AOR]: 1.30; 95% confidence interval [CI]: 1.01-1.68), social support (AOR being married: 1.33; 95% CI: 1.04-1.70; AOR having a nonworking relative: 1.71; 95% CI: 1.28-2.29), a high care level (AOR Care Level II: 2.79; 95% CI: 2.06-3.79, AOR Care Level III: 4.96; 95% CI: 3.40-7.24), and living in a rural municipality (AOR: 1.36; 95% CI: 1.01-1.84) were major factors favoring home death compared with institutional death.
  
  
  CONCLUSIONS
  Compared with other European countries, home death is still a frequent event in the federal state of Rhineland-Palatinate. Regional health policy should consider the actual distribution of place of death and corresponding predicting factors when establishing specialized palliative care home services as designed by recent German health legislation.
authors.affiliation: Institute of Occupational, Social and Environmental Medicine, University Medical Center of Johannes Gutenberg University of Mainz, Mainz, Germany. escobar@uni-mainz.de
authors.forename: Luis Carlos
authors.initials: LC
authors.lastname: Escobar Pinzón
authors.forename: Martin
authors.initials: M
authors.lastname: Weber
authors.forename: Matthias
authors.initials: M
authors.lastname: Claus
authors.forename: Sabine
authors.initials: S
authors.lastname: Fischbeck
authors.forename: Michael
authors.initials: M
authors.lastname: Unrath
authors.forename: Tanja
authors.initials: T
authors.lastname: Martini
authors.forename: Eva
authors.initials: E
authors.lastname: Münster
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D002648:Child; D002675:Child, Preschool; D003643:Death; D005260:Female; D005858:Germany / Q000453:epidemiology; D018575:Home Care Services, Hospital-Based / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000706:statistics & numerical data*; D013727:Terminal Care / Q000706:statistics & numerical data*; D019452:Terminally Ill / Q000706:statistics & numerical data*; D055815:Young Adult