International study of the place of death of people with cancer: a population-level comparison of 14 countries across 4 continents using death certificate data

Br J Cancer. 2015 Nov 3;113(9):1397-404. doi: 10.1038/bjc.2015.312. Epub 2015 Sep 1.


Background: Where people die can influence a number of indicators of the quality of dying. We aimed to describe the place of death of people with cancer and its associations with clinical, socio-demographic and healthcare supply characteristics in 14 countries.

Methods: Cross-sectional study using death certificate data for all deaths from cancer (ICD-10 codes C00-C97) in 2008 in Belgium, Canada, Czech Republic, England, France, Hungary, Italy, Mexico, the Netherlands, New Zealand, South Korea, Spain (2010), USA (2007) and Wales (N=1,355,910). Multivariable logistic regression analyses evaluated factors associated with home death within countries and differences across countries.

Results: Between 12% (South Korea) and 57% (Mexico) of cancer deaths occurred at home; between 26% (Netherlands, New Zealand) and 87% (South Korea) occurred in hospital. The large between-country differences in home or hospital deaths were partly explained by differences in availability of hospital- and long-term care beds and general practitioners. Haematologic rather than solid cancer (odds ratios (ORs) 1.29-3.17) and being married rather than divorced (ORs 1.17-2.54) were most consistently associated with home death across countries.

Conclusions: A large country variation in the place of death can partly be explained by countries' healthcare resources. Country-specific choices regarding the organisation of end-of-life cancer care likely explain an additional part. These findings indicate the further challenge to evaluate how different specific policies can influence place of death patterns.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Cause of Death
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Death Certificates
  • Female
  • Hospitals / statistics & numerical data
  • Humans
  • Infant
  • Infant, Newborn
  • Long-Term Care / statistics & numerical data
  • Male
  • Middle Aged
  • Neoplasms / mortality*
  • Palliative Care / statistics & numerical data*
  • Terminal Care / statistics & numerical data*
  • Young Adult