Determinants in the place of death for people with different cancer types: a national population-based study

Abstract

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. Material and 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. Conclusion: 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.

What socio-economic factors determine place of death for people with life-limiting illness? A systematic review and appraisal of methodological rigour

“…Fourteen papers specifically stated, that they only included adult patients. 21,28–30,35,39,40,42,46,47,50,51,53,54…”

“…22,24 However, studies from other continents found the opposite, namely, that a higher education level was associated with dying at home (ORs between 1.17 and 1.96). 25,36,50,54…”

“…22,24,29,38,[40][41][42]49,52 Concerning the age of the study populations, three types of papers were identified: a. Fourteen papers specifically stated, that they only included adult patients. 21,[28][29][30]35,39,40,42,46,47,50,51,53,54 b. Fourteen studies did not explicitly state the lower age limit but reported a range from birth to an adult age, for example, 0-65 years, [25][26][27][31][32][33][34]36,37,41,43,44,48,49 and the percentages of these youngest age-groups were low (1.0%-32.5%) in all 14 papers. Also, in eight of these papers, the diagnoses of the included patients indicated that only adults were included (ALS, 27 COPD, 31,33,44 lung cancer, 31,48 IPD, 33 HIV 32 and chronic life-limiting diseases 34,…”

“…52 Education was included as a variable in 13 studies. [22][23][24][25]29,32,36,38,43,45,49,50,54 The operationalisation of the variable ranged from a dichotomous division of 'low/high level' of education to a multinomial division with up to five levels of education. 23 Seven studies included occupation as a variable.…”

“…24 Urbanisation as a variable was examined in 23 papers. [23][24][25][26][29][30][31][32][33]35,36,[38][39][40][41][42][43][44]47,[49][50][51]54 The included studies used noticeably different definitions of urbanisation; eight studies used a dichotomous division of 'rural versus urban' 23,24,36,38,44,50,54 and the remaining studies used a multinomial division with three to six degrees of urbanisation.…”