Influences on place of death in Botswana

2010 ◽  
Vol 8 (2) ◽  
pp. 177-185 ◽  
Author(s):  
Mark Lazenby ◽  
Tony Ma ◽  
Howard J. Moffat ◽  
Marjorie Funk ◽  
M. Tish Knobf ◽  
...  
Keyword(s):  
Cause Of Death ◽  
Causes Of Death ◽  
Death Certificate ◽  
Female Gender ◽  
Place Of Death ◽  
Hospital Deaths ◽  
The Mean ◽  
Dying At Home ◽  
At Home

AbstractObjective:There is an emerging body of research aimed at understanding the determinants of place of death, as where people die may influence the quality of their death. However, little is known about place of death for people of Southern Africa. This study describes place of death (home or hospital) and potential influencing factors (cause of death, age, gender, occupation, and district of residence).Method:We collected the death records for years 2005 and 2006 for all adult non-traumatic deaths that occurred in Botswana, described them, and looked for associations using bivariate and multivariate analyses.Results:The evaluable sample consisted of 18,869 death records. Home deaths accounted for 36% of all deaths, and were predominantly listed with “unknown” cause (82.3%). Causes of death for hospital deaths were HIV/AIDS (49.7%), cardiovascular disease (13.8%), and cancer (6.6%). The mean age at the time of all deaths was 53.2 years (SD = 20.9); with 61 years (SD = 22.5) for home deaths and 48.8 years (SD = 18.6) for hospital deaths (p < .001). Logistic regression analysis revealed the following independent predictors of dying at home: unknown cause of death; female gender; >80 years of age; and residing in a city or rural area (p < .05).Significance of Results:A major limitation of this study was documentation of cause of death; the majority of people who died at home were listed with an unknown cause of death. This finding impeded the ability of the study to determine whether cause of death influenced dying at home. Future study is needed to determine whether verbal autopsies would increase death-certificate listings of causes of home deaths. These data would help direct end-of-life care for patients in the home.

scholarly journals Disparities in place of death for patients with hematological malignancies, 1999 to 2015

2019 ◽  
Vol 3 (3) ◽  
pp. 333-338 ◽  
Author(s):  
Fumiko Chino ◽  
Arif H. Kamal ◽  
Junzo Chino ◽  
Thomas W. LeBlanc
Keyword(s):  
End Of Life Care ◽  
Multivariate Regression ◽  
Hematological Malignancies ◽  
Death Certificate ◽  
Multivariate Regression Analysis ◽  
Hematologic Malignancies ◽  
Place Of Death ◽  
Hospital Deaths ◽  
Dying At Home ◽  
At Home

Abstract Patients with hematologic malignancies (HMs) often receive aggressive end-of-life care and less frequently use hospice. Comprehensive longitudinal reporting on place of death, a key quality indicator, is lacking. Deidentified death certificate data were obtained via the National Center for Health Statistics for all HM deaths from 1999 to 2015. Multivariate regression analysis (MVA) was used to test for disparities in place of death associated with sociodemographic variables. During the study period, there were 951 435 HM deaths. Hospital deaths decreased from 54.6% in 1999 to 38.2% in 2015, whereas home (25.9% to 32.7%) and hospice facility deaths (0% to 12.1%) increased (all P &lt; .001). On MVA of all cancers, HM patients had the lowest odds of home or hospice facility death (odds ratio [OR], 0.55; 95% confidence interval, 0.54-0.55). Older age (40-64 years: OR, 1.34; ≥65 years: OR, 1.89), being married (OR, 1.62), and having myeloma (OR, 1.34) were associated with home or hospice facility death, whereas being black or African American (OR, 0.68), Asian (OR, 0.58), or Hispanic (OR, 0.84) or having chronic leukemia (OR, 0.83) had decreased odds of dying at home or hospice (all P &lt; .001). In conclusion, despite hospital deaths decreasing over time, patients with HMs remained more likely to die in the hospital than at home.

Place of death and associated factors: a population-based study using death certificate data

2019 ◽  
Vol 29 (4) ◽  
pp. 608-615 ◽  
Author(s):  
María José Cabañero-Martínez ◽  
Andreu Nolasco ◽  
Inmaculada Melchor ◽  
Manuel Fernández-Alcántara ◽  
Julio Cabrero-García
Keyword(s):  
Marital Status ◽  
Cause Of Death ◽  
Death Certificate ◽  
Population Based ◽  
Place Of Death ◽  
Population Based Study ◽  
Urbanization Level ◽  
Sociodemographic Variables ◽  
Death Certificate Data ◽  
At Home

Abstract Background Although studies suggest that most people prefer to die at home, not enough is known about place of death patterns by cause of death considering sociodemographic factors. The objective of this study was to determine the place of death in the population and to analyze the sociodemographic variables and causes of death associated with home as the place of death. Methods Cross-sectional population-based study. All death certificate data on the residents in Spain aged 15 or over who died in Spain between 2012 and 2015 were included. We employed multinomial logistic regression to explore the relation between place of death, sociodemographic variables and cause of death classified according to the International Classification of Diseases, 10th revision, and to conditions needing palliative care. Results Over half of all deaths occurred in hospital (57.4%), representing double the frequency of deaths that occurred at home. All the sociodemographic variables (sex, educational level, urbanization level, marital status, age and country of birth) were associated with place of death, although age presented the strongest association. Cause of death was the main predictor with heart disease, neurodegenerative disease, Alzheimer’s disease, dementia and senility accounting for the highest percentages of home deaths. Conclusions Most people die in hospital. Cause of death presented a stronger association with place of death than sociodemographic variables; of these latter, age, urbanization level and marital status were the main predictors. These results will prove useful in planning end-of-life care that is more closely tailored to people’s circumstances and needs.

scholarly journals Place of death and other factors associated with unnatural mortality in patients with serious mental disorders: population-based retrospective cohort study

BJPsych Open ◽  
2019 ◽  
Vol 5 (2) ◽  
Author(s):  
Rebecca Wilson ◽  
Fiona Gaughran ◽  
Tara Whitburn ◽  
Irene J. Higginson ◽  
Wei Gao
Keyword(s):  
Mental Disorders ◽  
Cause Of Death ◽  
Causes Of Death ◽  
Multivariable Analysis ◽  
Spectrum Disorder ◽  
Place Of Death ◽  
Healthcare Outcomes ◽  
Schizophrenia Spectrum Disorder ◽  
Schizophrenia Spectrum ◽  
At Home

BackgroundPatients with serious mental disorders have poorer healthcare outcomes at the end of life and are at greater risk of dying from unnatural causes.AimsTo explore place of death and demographic and clinical correlates of unnatural causes of death in patients with serious mental disorders.MethodRoutinely collected patient data were used to explore bivariate and adjusted associations between covariates and natural/unnatural cause of death.ResultsIn multivariable analysis (n = 1029), dying at home (odds ratio (OR) = 1.87, 95% CI 1.03–3.40), ‘other’ locations (OR = 16.50, 95% CI 7.57–36.00), younger age (OR = 17.26, 95% CI 8.28–36.00) and a diagnosis other than schizophrenia spectrum disorder (OR = 1.69, 95% CI 1.04–2.73) were correlates of unnatural cause of death.ConclusionsDeaths from unnatural causes were high and more likely to occur at home and non-healthcare settings. Unnatural causes of death were higher in younger patients with non-schizophrenia spectrum disorder diagnoses.Declaration of interestF.G. has received support or honoraria for CME, advisory work and lectures from Bristol-Myers Squibb, Janssen, Lundbeck, Otsuka, Roche, and Sunovion, and has a family member with professional links to Lilly and GSK, including shares.

scholarly journals Socioeconomic inequalities in the place of death in urban small areas of three Mediterranean cities

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Andreu Nolasco ◽  
Manuel Fernández-Alcántara ◽  
Pamela Pereyra-Zamora ◽  
María José Cabañero-Martínez ◽  
José M. Copete ◽  
...  
Keyword(s):  
Cause Of Death ◽  
Residential Care ◽  
Census Tract ◽  
Deprivation Level ◽  
Socioeconomic Inequalities ◽  
Place Of Death ◽  
Country Of Birth ◽  
Explanatory Variables ◽  
Dying At Home ◽  
At Home

Abstract Background Dying at home is the most frequent preference of patients with advanced chronic conditions, their caregivers, and the general population. However, most deaths continue to occur in hospitals. The objective of this study was to analyse the socioeconomic inequalities in the place of death in urban areas of Mediterranean cities during the period 2010–2015, and to assess if such inequalities are related to palliative or non-palliative conditions. Methods This is a cross-sectional study of the population aged 15 years or over. The response variable was the place of death (home, hospital, residential care). The explanatory variables were: sex, age, marital status, country of birth, basic cause of death coded according to the International Classification of Diseases, 10th revision, and the deprivation level for each census tract based on a deprivation index calculated using 5 socioeconomic indicators. Multinomial logistic regression models were adjusted in order to analyse the association between the place of death and the explanatory variables. Results We analysed a total of 60,748 deaths, 58.5% occurred in hospitals, 32.4% at home, and 9.1% in residential care. Death in hospital was 80% more frequent than at home while death in a nursing home was more than 70% lower than at home. All the variables considered were significantly associated with the place of death, except country of birth, which was not significantly associated with death in residential care. In hospital, the deprivation level of the census tract presented a significant association (p < 0.05) so that the probability of death in hospital vs. home increased as the deprivation level increased. The deprivation level was also significantly associated with death in residential care, but there was no clear trend, showing a more complex association pattern. No significant interaction for deprivation level with cause of death (palliative, not palliative) was detected. Conclusions The probability of dying in hospital, as compared to dying at home, increases as the socioeconomic deprivation of the urban area of residence rises, both for palliative and non-palliative causes. Further qualitative research is required to explore the needs and preferences of low-income families who have a terminally-ill family member and, in particular, their attitudes towards home-based and hospital-based death.

scholarly journals Garbage codes as causes of death and quality of mortality statistics in Belo Horizonte, Brazil

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
L Ishitani ◽  
R Teixeira ◽  
D Abreu ◽  
L Paixão ◽  
E França
Keyword(s):  
Causes Of Death ◽  
Health Planning ◽  
Age Groups ◽  
International Classification Of Diseases ◽  
Mortality Statistics ◽  
Classification Of Diseases ◽  
Icd 10 ◽  
Hospital Deaths ◽  
Belo Horizonte

Abstract Background Quality of cause-of-death information is fundamental for health planning. Traditionally, this quality has been assessed by the analysis of ill-defined causes from chapter XVIII of the International Classification of Diseases - 10th revision (ICD-10). However, studies have considered other useless diagnoses for public health purposes, defined, in conjunction with ill-defined causes, as garbage codes (GC). In Brazil, despite the high completeness of the Mortality Information System, approximately 30% of deaths are attributable to GCs. This study aims to analyze the frequency of GCs in Belo Horizonte municipality, the capital of Minas Gerais state, Brazil. Methods Data of deaths from 2011 to 2013 in Belo Horizonte were analyzed. GCs were classified according to the GBD 2015 study list. These codes were classified in: a) GCs from chapter XVIII of ICD-10 (GC-R), and b) GC from other chapters of ICD-10 (GC-nonR). Proportions of GC were calculated by sex, age, and place of occurrence. Results In Belo Horizonte, from the total of 44,123 deaths, 5.5% were classified as GC-R. The majority of GCs were GC-nonR (25% of total deaths). We observed a higher proportion of GC in children (1 to 4 years) and in people aged over 60 years. GC proportion was also higher in females, except in the age-groups under 1 year and 30-59 years. Home deaths (n = 7,760) had higher proportions of GCs compared with hospital deaths (n = 30,182), 36.9% and 28.7%, respectively. The leading GCs were the GC-R other ill-defined and unspecified causes of death (ICD-10 code R99)), and the GCs-nonR unspecified pneumonia (J18.9), unspecified stroke (I64), and unspecified septicemia (A41.9). Conclusions Analysis of GCs is essential to evaluate the quality of mortality information. Key messages Analysis of ill-defined causes (GC-R) is not sufficient to evaluate the quality of information on causes of death. Causes of death analysis should consider the total GC, in order to advance the discussion and promote adequate intervention on the quality of mortality statistics.

scholarly journals Availability of home palliative care services and dying at home in conditions needing palliative care: A population-based death certificate study

2020 ◽  
Vol 34 (4) ◽  
pp. 504-512 ◽  
Author(s):  
Miharu Nakanishi ◽  
Asao Ogawa ◽  
Atsushi Nishida
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
Primary Care Physicians ◽  
Death Certificate ◽  
Care Services ◽  
Primary Care Services ◽  
Hospital Beds ◽  
Palliative Care Services ◽  
Dying At Home ◽  
At Home

Background: Avoiding inappropriate care transition and enabling people with chronic diseases to die at home have become important health policy issues. Availability of palliative home care services may be related to dying at home. Aim: After controlling for the presence of hospital beds and primary care physicians, we examined the association between availability of home palliative care services and dying at home in conditions requiring such services. Design: Death certificate data in Japan in 2016 were linked with regional healthcare statistics. Setting/participants: All adults (18 years or older) who died from conditions needing palliative care in 2016 in Japan were included. Results: There were 922,756 persons included for analysis. Malignant neoplasm (37.4%) accounted for most decedents, followed by heart disease including cerebrovascular disease (31.4%), respiratory disease (14.7%) and dementia/Alzheimer’s disease/senility (11.5%). Of decedents, 20.8% died at home or in a nursing home and 79.2% died outside home (hospital/geriatric intermediate care facility). Death at home was more likely in health regions with fewer hospital beds and more primary care physicians, in total and per condition needing palliative care. Number of home palliative care services was negatively associated with death at home. The adjustment for home palliative care services disappeared in heart disease including cerebrovascular disease and reversed in respiratory disease. Conclusion: Specialised home palliative care services may be suboptimal, and primary care services may serve as a key access point in providing baseline palliative care to people with conditions needing palliative care. Therefore, primary care services should aim to enhance their palliative care workforce.

scholarly journals Trends in place of death in a small developing country: a population-level study using death certificate data

2020 ◽  
pp. jech-2019-213285
Author(s):  
Nicholas Jennings ◽  
Kenneth Chambaere ◽  
Luc Deliens ◽  
Joachim Cohen
Keyword(s):  
Trinidad And Tobago ◽  
Death Certificate ◽  
Population Level ◽  
Place Of Death ◽  
Death Certificate Data ◽  
Care Facilities ◽  
Government Hospitals ◽  
Hospital Deaths ◽  
Private Homes ◽  
Level Analysis

BackgroundValuable information for planning future end-of-life care (EOLC) services and care facilities can be gained by studying trends in place of death (POD). Scarce data exist on the POD in small developing countries. This study aims to examine shifts in the POD of all persons dying between 1999 and 2010 in Trinidad and Tobago, to draw conclusions about changes in the distribution of POD over time and the possible implications for EOLC practice and policy.MethodsA population-level analysis of routinely collected death certificate data of the most recent available fully coded years at the time of the study—1999 to 2010. Observed proportions for the POD of all deaths were standardised according to the age, sex and cause of death distribution in 1999. Trends for a subgroup of persons who died from causes indicative of a palliative care (PC) need were also examined.ResultsThe proportion of deaths in government hospitals increased from 48.9% to 55.4% and decreased from 38.7% to 29.7% at private homes. There was little variation between observed and standardised rates. The decrease in home deaths was stronger when the PC subcategory was considered, most notably from cancer.ConclusionInternationally, the proportion of deaths at institutions is increasing. A national strategy on palliative and EOLC is needed to facilitate the increasing number of people who seek EOLC at government hospitals in Trinidad and Tobago, including an investigation into the reasons for the trend. Alternatives to accommodate out-of-hospital deaths can be considered.

scholarly journals Multiple cause of death analysis in multiple sclerosis

Neurology ◽  
2020 ◽  
Vol 94 (8) ◽  
pp. e820-e829 ◽  
Author(s):  
Katharine Harding ◽  
Feng Zhu ◽  
Mohammed Alotaibi ◽  
Thomas Duggan ◽  
Helen Tremlett ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Respiratory Disease ◽  
Cause Of Death ◽  
Aspiration Pneumonia ◽  
Causes Of Death ◽  
Death Certificate ◽  
Chronic Respiratory Disease

ObjectiveTo gain a better understanding of the complex patterns of causes that contribute to death due to multiple sclerosis (MS) by assessing the relationship between MS and other causes of death listed on death certificates.MethodsMultiple cause of death data for all adult deaths (aged ≥18 years) in British Columbia, Canada, between 1986 and 2013 were accessed. All causes, as listed on the death certificate, whether underlying or contributing, were considered “any mention” causes. The associations between mention of MS on the death certificate and mention of other causes of death were examined by logistic regression, adjusted for age, sex, and calendar year (Bonferroni-corrected α level = 0.002). Findings were also sex-stratified.ResultsAmong 771,288 deaths, MS was mentioned on 2,153 certificates. If MS was mentioned (versus not mentioned), there was a greater chance that specific conditions contributed to the death: respiratory infection (adjusted odds ratio [aOR], 3.03 [95% confidence interval (CI), 2.73–3.36]), aspiration pneumonia (aOR, 7.15 [95% CI, 6.23–8.22]), urinary tract infection (UTI) (aOR, 10.2 [95% CI, 8.7–12.0]), other infection including sepsis (aOR, 1.34 [95% CI, 1.15–1.56]), and skin disease (aOR, 5.06 [95% CI, 3.96–6.46]). Sex differences existed for urinary tract infection (men: aOR, 14.9 [95% CI, 11.5–19.3]; women: aOR, 8.00 [95% CI, 6.53–9.81]) and chronic respiratory disease (men = aOR, 1.36 [95% CI, 1.14–1.63]; women = aOR, 0.97 [95% CI, 0.84–1.13]).ConclusionsDeaths attributed to MS were commonly caused by infection (especially respiratory and urinary tract–related); conditions associated with advanced disability and immobility, such as aspiration pneumonia; and chronic respiratory disease in men. All are potentially modifiable; interventions that reduce the frequency or severity of these complications could improve survival in MS.

scholarly journals Predictors of Death at Home Among Cancer Patients in Israel: A Population-based Study

2020 ◽  
Author(s):  
Yakir Rottenberg ◽  
Gil Goldzweig ◽  
Adir Shaulov
Keyword(s):  
Cancer Patients ◽  
Binary Logistic Regression ◽  
Hematologic Malignancies ◽  
Population Based ◽  
Place Of Death ◽  
Personal Factors ◽  
Low Socioeconomic ◽  
Predictive Variables ◽  
Dying At Home ◽  
At Home

Abstract Background: Most cancer patients want to die at home; however, many die in hospital. The aim of the current study is to elucidate the correlation between dying at home and various personal factors in the Israeli population of cancer patients.Methods: Data on cancer incidence (2008-2015) and death (2008-2017) was provided by the Israeli Central Bureau of Statistics and the Israel National Cancer Registry. Binary logistic regression analyses were performed to assess odds ratios for death at home following cancer diagnosis while controlling for age, sex, ethnicity, years of education, residential socioeconomic score, and time from diagnosis. We also assessed the relation between place of death and specific cancer sites, as well as the time trend from 2008-2017.Results: About one quarter (26.7%) of the study population died at home. Death at home was most frequent among patients diagnosed with brain tumors (37.0%), while it was the lowest among patients with hematologic malignancies (lymphoma and leukemia, 20.3% and 20.0%, respectively). Rates of dying at home among patients with residential socioeconomic scores of 1, 2-9, and 10 were about 15%, 30%, and 42.9%, respectively. In patients from the 4th to the 7th decades of life, rates of death at home increased at a linear rate that increased exponentially from the 8th decade onwards. After controlling for potential confounders, predictive variables for death at home included age (HR=1.020 per year), male sex (HR=1.18), years of education (HR=1.029 per year), and time from diagnosis (HR=1.003 per month, all p<0.001). No trend was seen from 2008-2013, while from 2014-2017 a slight increase in the rate of death at home was seen each year.Conclusions: These results indicate that inequality exists among cancer patients in Israel regarding the opportunity to die at home. The present findings stress the importance of delivering efficient palliative care at home, mainly for patients with hematologic malignancies, younger patients, and patients of very low socioeconomic statuses. Understanding the complex mechanisms whereby patient preferences and the above variables may determine the preferred place of death remains an important research priority.

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