Place of death of people with conditions needing palliative care in the different autonomous communities (Regions) of Spain

Abstract

Background. Dying at home is the most frequent prefer-ence, with the institutionalized context being the most common place of death. To determine the place of death in conditions requiring palliative care of residents in Spain aged 15 or over by Autonomous Community (AC) and to ex-amine the relationship with oncological vs. non-oncological causes of death. Methods. Population-based cross-sectional study analysing medical death certificates. Adjusted effects of socio-demo-graphic variables, AC and causes on the place of death were estimated calculating odds of death in hospital vs. at home (OH/H) and in a nursing home vs. at home (ON/H), and odds ratio (ORH/H and ORN/H) by multinomial logistic regression models. Results. During 2012-2015, 1,611,767 deaths were record-ed, 64.8% corresponding to the target population. Death in hospital was 77% more frequent than death at home, while death in a nursing home was 53% lower. Male sex, lower age, lower academic level, place of birth other than Spain, bigger city size and civil status other than married displayed a relationship with death in hospital, while the same variables except female sex and higher age did so in a nursing home. Adjusted OH/H > 1 and ON/H < 1 were observed in all AC, except Catalonia. Oncological causes made OH/H < 1 in almost 50% of AC, while ON/H continue to be < 1. Conclusions. Most deaths were in hospital and fewer at nursing homes, despite oncological causes increasing deaths at home (adjusted effect).