Determinants in the place of death for people with different cancer types: a national population-based study.
BACKGROUND
Place of death has for the past decade increasingly come to be regarded as a robust indicator of how palliative care is organized and provided, and is also recognized as an important factor for well being at the end of life. Variations in place of cancer deaths have previously been reported in the context of country-specific healthcare organization, but without differentiating between cancer types and national regional variations. Our aim was to examine, at a population level, where people with cancer diseases die in Sweden, and to investigate associations of place of death and cancer type with individual, socioeconomic and geographical characteristics of the deceased.


METHODS
This population level study is based on death certificate data (sex; age; underlying cause of death and place of death) and population register data (educational attainment, marital status, living arrangements, area of residence, degree of urbanization, and healthcare region) of all 2012 cancer deaths in Sweden, with a registered place of death (hospital, nursing home, home, other places). Data were explored descriptively. To investigate associations between place of death and cancer types, and individual, socioeconomic and environmental characteristics, a series of multivariable logistic regression analyses were performed.


RESULTS
The most frequent type of cancer death occurring at home was upper gastrointestinal cancer (25.6%) and the least frequent was hematological cancer (15.2%). Regional variations in cancer deaths occurring at home ranged from 17.1% to 28.4%. Factors associated with place of death by cancer type were age, educational attainment, marital status, healthcare regions and degree of urbanization.


CONCLUSIONS
Large healthcare regional variations in place of death among different cancer types were found. The socioeconomic inequality previously demonstrated for screening, diagnostic and treatment processes, rehabilitation and survival thus also seems to be reflected in the place of death.
a Department of Health Care Science , Palliative Research Centre (JÖ, CH), Ersta Sköndal University College , Stockholm , Sweden.|b Institute of Health and Care Sciences, University of Gothenburg Centre for Person-Centred Care (JÖ), Sahlgrenska Academy at the University of Gothenburg , Sweden.
Joakim
J
Öhlén
c End-of-Life Care Research Group (JC) , Vrije Universiteit Brussel (VUB) and Ghent University , Brussels , Belgium.
Joachim
J
Cohen
a Department of Health Care Science , Palliative Research Centre (JÖ, CH), Ersta Sköndal University College , Stockholm , Sweden.|d Department of Neurobiology , Care Science and Society (CH), Karolinska Institutet , Stockholm , Sweden.
Cecilia
C
Håkanson
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000145:classification* / Q000401:mortality* / Q000473:pathology; D009735:Nursing Homes / Q000706:statistics & numerical data; D010166:Palliative Care / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data; D012042:Registries; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013548:Sweden / Q000453:epidemiology; D013727:Terminal Care / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data*; D055815:Young Adult