title: Regional variation in the practice of euthanasia and physician-assisted suicide in the Netherlands.
abstract: BACKGROUND
  The practice of euthanasia and physicianassisted suicide has been compared between countries, but it has not been compared between regions within the Netherlands. This study assesses differences in the frequencies, characteristics, and trends of euthanasia and physician-assisted suicide between five regions in the Netherlands and tries to explain the differences by demographic, socioeconomic, and health-related differences between these regions.
  
  
  METHODS
  Data on the frequencies, characteristics, and trends of euthanasia and physician-assisted suicide for each region and each year from 2002 through 2014 were derived from the annual reports of the Regional Review Committees. Averages and trends were determined using a regression model with the regions and years as independent variables. Demographic, socioeconomic, and health-related variables for each region and each year were derived from the Central Bureau for Statistics and added to the model as covariates.
  
  
  RESULTS
  The frequencies, characteristics, and trends of euthanasia and physician-assisted suicide differed between the regions, whereas the frequencies of non-assisted suicide did not differ. Euthanasia and physician-assisted suicide were most frequent and were performed most often by general practitioners, in patients with cancer, in the patient's home, in North Holland. The regional differences remained after adjustment for demographic, socioeconomic, and health-related differences between the regions.
  
  
  CONCLUSIONS
  More detailed research is needed to specify how and why the practice of euthanasia and physicianassisted suicide differs between regions in the Netherlands and to what extent these differences reflect a deficiency in the quality of care, such as other forms of regional variation in health care practice.
authors.affiliation: Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: J J E
authors.initials: JJ
authors.lastname: Koopman
authors.forename: H
authors.initials: H
authors.lastname: Putter
mesh_terms: D002318:Cardiovascular Diseases; D005065:Euthanasia / Q000639:trends*; D058006:General Practice; D005843:Geography; D006801:Humans; D009369:Neoplasms; D009422:Nervous System Diseases; D009426:Netherlands; D017236:Suicide, Assisted / Q000639:trends*