title: A population-level study of place of death and associated factors in Sweden.
abstract: OBJECTIVE
  The aims of this study were to examine, on a population level, where people die in Sweden, and to investigate associations between place of death and underlying cause of death, socioeconomic and environmental characteristics, with a particular interest in people dying from life-limiting conditions typically in need of palliative care.
  
  
  METHODS
  This population-level study is based on death certificate data for all deceased individuals in Sweden in 2012, with a registered place of death (n=83,712). Multivariable logistic regression was performed to investigate associations between place of death and individual, socioeconomic and environmental characteristics.
  
  
  RESULTS
  The results show that, in 2012, 42.1% of all deaths occurred in hospitals, 17.8% occurred at home and 38.1% in nursing home facilities. Individuals dying of conditions indicative of potential palliative care needs were less likely to die in hospital than those dying of other conditions (OR = 0.73; 95% CI = 0.70-0.77). Living at home in urban areas was associated with higher likelihood of dying in hospital or in a nursing home (OR = 1.04 and 1.09 respectively). Educational attainment and marital status were found to be somewhat associated with the place of death.
  
  
  CONCLUSIONS
  The majority of deaths in Sweden occur in institutional settings, with comparatively larger proportions of nursing home deaths than most countries. Associations between place of death and other variables point to inequalities in availability and/or utilization of health services at the end of life.
authors.affiliation: Palliative Research Centre and Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden Department of Neurobiology, Care science and Society, Karolinska Institutet, Huddinge, Sweden cecilia.hakanson@esh.se.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Håkanson
authors.affiliation: Palliative Research Centre and Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden Institute of Health and Care Sciences, The Sahlgrenska Academy and University of Gothenburg Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.
authors.forename: Joakim
authors.initials: J
authors.lastname: Öhlén
authors.affiliation: Department of Neurobiology, Care science and Society, Karolinska Institutet, Huddinge, Sweden.
authors.forename: Lucas
authors.initials: L
authors.lastname: Morin
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.
authors.forename: Joachim
authors.initials: J
authors.lastname: Cohen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003643:Death; D003644:Death Certificates; D005260:Female; D054625:Healthcare Disparities; D006699:Home Care Services / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data*; D010166:Palliative Care / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D013548:Sweden / Q000453:epidemiology; D019452:Terminally Ill / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Death certificates; Sweden; health care disparities; palliative care; place of death; policy; population; public health; socioeconomic factors