title: In-region versus out-of-region hospitalizations at the end of life among older rural residents: the relationship between personal and system-related factors.
abstract: BACKGROUND
  Even though a large segment of the population lives in rural areas, relatively little attention has been paid in the literature to date to hospital use at the end of life among rural residents. The objective of this study was to examine factors associated with in- or out-of-region hospitalizations at the end of life among older rural residents.
  
  
  METHODS
  The study included all community-dwelling adults aged 65 or older living in rural regions of a mid-Western Canadian province who had died in fiscal years 2003-04 to 2005-06, as determined from Vital Statistics data (N = 5,550). Complete hospital discharge abstract data were used to identify in- or out-of-region hospitalizations in the last 6 months before death and on the day of death. The type of out-of-region hospitals older adults were admitted to was also examined (urban tertiary hospital, urban community hospital, and rural hospital).
  
  
  RESULTS
  Twenty percent of hospitalizations and 21% of hospital deaths occurred in a hospital that was out of older adults' region of residence. Compared with decedents aged 65-74, those aged 75-84 and even more so those aged 85+ had reduced odds of being hospitalized out of region or dying in an out-of-region hospital. Those 85+ years old also had reduced odds of being hospitalized in a (out-of-region) tertiary hospital. Higher hospital bed rates and physician rates were associated with reduced odds of out-of-region hospitalization and hospital death.
  
  
  CONCLUSIONS
  Efforts should focus on recruiting physicians to those rural areas with low physician rates, as well as finding mechanisms to retain physicians in those rural regions.
authors: PhD. Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. menec@cc.umanitoba.ca.
authors: Verena H
authors: VH
authors: Menec
authors: Scott
authors: S
authors: Nowicki
authors: Philip D
authors: PD
authors: St John
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015331:Cohort Studies; D003153:Community Health Services / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006780:Hospitals, Rural; D006801:Humans; D016015:Logistic Models; D008297:Male; D008350:Manitoba; D012111:Residence Characteristics; D012424:Rural Population; D013727:Terminal Care / Q000706:statistics & numerical data