Palliat Med. 2018 Apr;32(4):891-901. doi: 10.1177/0269216317743961. Epub 2017 Dec 13.

Risk factors for hospital death in conditions needing palliative care: Nationwide population-based death certificate study.

Gomes B^1,², Pinheiro MJ³, Lopes S^3,⁴, de Brito M², Sarmento VP^2,⁵, Lopes Ferreira P^6,⁷, Barros H⁸.

Author information

1: 1 Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
2: 2 Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK.
3: 3 National School of Public Health, Universidade Nova de Lisboa, Lisbon, Portugal.
4: 4 Public Health Research Centre, National School of Public Health, Universidade Nova de Lisboa, Lisbon, Portugal.
5: 5 Hospital Espírito Santo de Évora, Évora, Portugal.
6: 6 Centre for Studies and Health Research of the University of Coimbra, Coimbra, Portugal.
7: 7 Faculty of Economics, University of Coimbra, Coimbra, Portugal.
8: 8 EPIUnit, Institute of Public Health of the University of Porto, Oporto, Portugal.

Abstract

BACKGROUND:

Most people would prefer to die at home as opposed to hospital; therefore, understanding mortality patterns by place of death is essential for health resources allocation.

AIM:

We examined trends and risk factors for hospital death in conditions needing palliative care in a country without integrated palliative care.

DESIGN:

This is a death certificate study. We examined factors associated with hospital death using logistic regression.

SETTING/PARTICIPANTS:

All adults (1,045,381) who died between 2003 and 2012 in Portugal were included. We identified conditions needing palliative care from main causes of death: cancer, heart/cerebrovascular, renal, liver, respiratory and neurodegenerative diseases, dementia/Alzheimer's/senility and HIV/AIDS.

RESULTS:

Conditions needing palliative care were responsible for 70.7% deaths ( N = 738,566, median age 80); heart and cerebrovascular diseases (43.9%) and cancer (32.2%) accounted for most. There was a trend towards hospital death (standardised percentage: 56.3% in 2003, 66.7% in 2012; adjusted odds ratio: 1.04, 95% confidence interval: 1.04-1.04). Hospital death risk was higher for those aged 18-39 years (3.46, 3.25-3.69 vs aged 90+), decreasing linearly with age; lower in dementia/Alzheimer's/senility versus cancer (0.13, 0.13-0.13); and higher for the married and in HIV/AIDS (3.31, 3.00-3.66). Effects of gender, working status, weekday and month of death, hospital beds availability, urbanisation level and deprivation were small.

CONCLUSION:

The upward hospital death trend and fact that being married are risk factors for hospital death suggest that a reliance on hospitals may coexist with a tradition of extended family support. The sustainability of this model needs to be assessed within the global transition pattern in where people die.