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Population-based study of dying in hospital in six European countries

End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels Joachim.Cohen{at}vub.ac.be

J Bilsen

End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels; Bioethics Institute, Ghent University, Ghent

J Addington-Hall

School of Nursing and Midwifery, Southampton University, Southampton

R Löfmark

Centre for Bioethics, LIME, Karolinska Institutet and Uppsala University, Stockholm

G Miccinesi

Centre for Study and Prevention of Cancer, Florence

S Kaasa

Norwegian University of Science and Technology Trondheim; The Palliative Medicine Unit, St Olavs University Hospital, Trondheim

B Onwuteaka-Philipsen

Department of Public and Occupational Health, EMGO Institute, VU University Medical Centre, Amsterdam

L Deliens

End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels; Department of Public and Occupational Health, EMGO Institute, VU University Medical Centre, Amsterdam

This study examined the proportion of deaths taking place in hospitals in six European countries in relation to demographic, epidemiologic and healthcare factors. Retrospective analyses were performed on a database integrating death certificate data of all deaths in 2002 in Sweden and 2003 in Belgium, England, Scotland, the Netherlands and Wales (N = 891,780). Data were linked with regional healthcare statistics. Of all deaths, from 33.9% (the Netherlands) to 62.8% (Wales) occurred in hospital. Large country differences in hospital deaths were partly explained by the availability of care home and hospital beds. Differences between countries were strikingly large in older patients and cancer patients. Older patients had a higher probability of dying in hospital in Sweden, Scotland, England and Wales than in Flanders and, in particular, in the Netherlands. Cancer patients often died in hospitals in Sweden but less frequently so in the Netherlands and England. Country differences in the proportion of patients dying in hospital are only partly the result of differences in health care provision, and are in particular larger for certain patient categories, suggesting country-specific end-of-life practices in these categories. These findings can contribute to rational public health policies aimed at reducing hospital deaths.

Key Words: death • death certificates • health services • hospitals • terminal care

Palliative Medicine, Vol. 22, No. 6, 702-710 (2008)
DOI: 10.1177/0269216308092285


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