Increasing Trend in Hospital Deaths Consistent among Older Decedents in Korea: A Population-based Study Using Death Registration Database, 2001–2014

Abstract

BackgroundWith improvement in hospice palliative care services and long-term care, Republic of Korea (hereafter South Korea) has recorded significant changes in places of death (e.g., hospital, home), especially among older adults. Over the last few decades, the most common places of death in South Korea were hospitals. However, Koreans, especially older adults, reportedly prefer to receive terminal care and eventually die at home. This study was conducted to investigate trends in places of death among older Korean adults and factors associated therewith.MethodsData were obtained from the Korean Death Registration Database maintained by the National Statistical Office. Decedents who died after the age of 65 years from 2001 to 2014 were included in the analysis. For descriptive analysis, proportions of places of death were analyzed and were used to plot graphs for visualizing trends during 13-year period. Logistic regression model was used to evaluate factors associated with places of death (hospital versus home).ResultsTwo million three hundred fifty eight thousand two hundred eleven older adult decedents were included in final analysis. Hospitals were the most common places of death (57.82%), followed by homes (32.12%). Dying at social welfare facilities was rare (2.61%). A gradual increase in hospital deaths (31.38% in 2001 to 75.30% in 2014) and a subsequent decrease in home deaths (60.44% to 15.95% over the same period) were noted. Hospital deaths were more likely for younger patients (ORs 1.28, 95% CI 1.27-1.29), females (ORs 1.28, 95% CI 1.27-1.29), and single/divorced or widowed individuals (ORs 1.77, 1.49 and 1.03 respectively). A higher education level and living in urban areas were strongly associated with a higher likelihood of dying in a hospital.ConclusionOver the study period, there was a consistent increasing trend in hospital deaths in South Korea. Trends in place of death and factors associated therewith should be more intensely investigated and monitored. Resources and facilities should be increased to fulfill end-of-life care preferences and the needs of an increasingly older population in South Korea.

Trends in site of death and health care utilization at the end of life: a population-based cohort study

“…For example, some studies suggest that rates of hospital death are declining, 10,11 whereas others do not. 12,13 In Canada, analyses between 1994 and 2004 found decreasing rates of hospital deaths; 10 however, whether this trend has continued or how it applies to other markers of end-of-life care is unclear.…”

Knowledge, attitude, confidence, and educational needs of palliative care in nurses caring for non-cancer patients: a cross-sectional, descriptive study

“…In addition, the global burden of serious healthrelated suffering will rapidly increase in low-income countries and among older people [4]. Further, although hospital deaths have consistently continued to increase [7,8], information related to patients' and families' experience of palliative care in a hospital setting is still limited [9].…”

Place of Death

“…Most developing countries are currently in a transition from phase I to phase II. For example, hospital deaths in South Korea gained a significant increase over the last two decades (Choi et al 2005;Mai et al 2018). On the other hand, most developed nations are in phase II or at the beginning of, or in a transition from, phase II to phase III, depending on their stages of development of palliative care (Gomes and Higginson 2006).…”