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

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.