International study of the place of death of people with cancer: a population-level comparison of 14 countries across 4 continents using death certificate data.
BACKGROUND
Where people die can influence a number of indicators of the quality of dying. We aimed to describe the place of death of people with cancer and its associations with clinical, socio-demographic and healthcare supply characteristics in 14 countries.


METHODS
Cross-sectional study using death certificate data for all deaths from cancer (ICD-10 codes C00-C97) in 2008 in Belgium, Canada, Czech Republic, England, France, Hungary, Italy, Mexico, the Netherlands, New Zealand, South Korea, Spain (2010), USA (2007) and Wales (N=1,355,910). Multivariable logistic regression analyses evaluated factors associated with home death within countries and differences across countries.


RESULTS
Between 12% (South Korea) and 57% (Mexico) of cancer deaths occurred at home; between 26% (Netherlands, New Zealand) and 87% (South Korea) occurred in hospital. The large between-country differences in home or hospital deaths were partly explained by differences in availability of hospital- and long-term care beds and general practitioners. Haematologic rather than solid cancer (odds ratios (ORs) 1.29-3.17) and being married rather than divorced (ORs 1.17-2.54) were most consistently associated with home death across countries.


CONCLUSIONS
A large country variation in the place of death can partly be explained by countries' healthcare resources. Country-specific choices regarding the organisation of end-of-life cancer care likely explain an additional part. These findings indicate the further challenge to evaluate how different specific policies can influence place of death patterns.
Department of Family Medicine & Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium.
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J
Cohen
Department of Family Medicine & Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium.
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L
Pivodic
ISPO Cancer Prevention and Research Institute, Clinical Epidemiology Unit, Via Oblate 2, Pal 28/A, 50142 Florence, Italy.
G
G
Miccinesi
Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
B D
BD
Onwuteaka-Philipsen
Hospice Waikato, 334 Cobham Drive, Hillcrest, Hamilton 3216, New Zealand.
W A
WA
Naylor
Faculty of Nursing, University of Alberta, 11405 87 Avenue, Edmonton, Alberta T6G 1C9, Canada.
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DM
Wilson
Center for Palliative Care, Michelska 1/7, Prague 140 00, Czech Republic.
M
M
Loucka
University of Pécs Medical School, 48-as tér 1, 7622 Pécs, Hungary.
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A
Csikos
Department of Family Medicine & Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium.
K
K
Pardon
Department of Family Medicine & Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium.
L
L
Van den Block
Information and Evaluation Service, Regional Ministry of Health in Andalusia, Av. Innovación, s/n - Edificio Arenas 1, 41071 Seville, Spain.
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M
Ruiz-Ramos
Department of General Internal Medicine, MD Anderson Cancer Center, The University of Texas, Houston, 515 Holcombe Blvd, Houston, TX 77030, USA.
M
M
Cardenas-Turanzas
Department of Health Science, Dongduk Women's University, 23-1 Hawolgok-dong, Seongbuk-gu, Seoul, South Korea.
Y
Y
Rhee
French National Observatory on End-of-Life Care, 35 Rue du Plateau, 75952 Paris CEDEX 19, France.
R
R
Aubry
Faculty of Health Sciences, University of Southampton, 104 Burgess Road, Southampton SO17 1BJ, Hampshire, UK.
K
K
Hunt
Cambia Palliative Care Center of Excellence, University of Washington Division of Geriatric Medicine, Box 359765, 401 Broadway, Suite 5123.11 Seattle, WA 98122, USA.
J
J
Teno
Department of Family Medicine & Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium.
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Houttekier
Department of Family Medicine & Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium.|Department of Medical Oncology, Ghent University Hospital, De Pintelaan 185, Building 6K12E, 9000 Ghent, Belgium.
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Deliens
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003644:Death Certificates; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008134:Long-Term Care / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality*; D010166:Palliative Care / Q000706:statistics & numerical data*; D013727:Terminal Care / Q000706:statistics & numerical data*; D055815:Young Adult