Dying at home or in an institution using death certificates to explore the factors associated with place of death

Health Policy. 2006 Oct;78(2-3):319-29. doi: 10.1016/j.healthpol.2005.11.003. Epub 2005 Dec 15.


Introduction: The knowledge of determinants of place of death is important for public health policy aimed at improving the quality of end-of-life care.

Methods: We investigated the influence of clinical, socio-demographic, residential and health care system factors on the place of death, using data from all 55,759 deaths in 2001 in Flanders (Belgium), gathered via official death certificates and data from anonymously linked health care statistics. A multivariate logistic regression was used to examine the associated factors (home versus hospital as dependent categories).

Results: Of all deaths in Flanders, 53.7% took place in hospital, 24.3% at home and 19.8% in a care home. The probability of home deaths varied by region, by rural or urban residence and by the hospital bed availability in the region and dying at home was less likely among those suffering from certain non-malignant chronic diseases, the less educated and those living alone.

Conclusion: Although most people wish to die at home, most deaths in Flanders (Belgium) in 2001 did not take place there. The clinical, socio-demographic and residential factors found to be associated with the place of death could serve as focal points for a policy to facilitate dying in the place of choice, including at home.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Belgium
  • Death Certificates*
  • Female
  • Home Care Services*
  • Hospital Mortality*
  • Humans
  • Male
  • Middle Aged
  • Palliative Care
  • Terminal Care
  • Terminally Ill*