Do social factors affect the place of death? Analysis of home versus institutional death over 20 years

Abstract

Background: Understanding determinants of place of death is important for public health policy aimed at improving the quality of end-of-life care. This study examines whether place of death is correlated with socioeconomic position (SEP). Method: Examined data are 92 283 deceased between 1977 and 1999, issued from a 1% sample of the French population linked to corresponding death certificate data. A multivariate logistic regression was used to examine the associated factors. Results: The place of death varied according to time period, demographic factors (age and gender), marital status and causes of death. Individuals with higher levels of education died more frequently at home. No clear link was found between place of death and social class. However, the self-employed and farmers were more likely to die at home. These results varied little among the study periods. Conclusion: Although people in France often prefer to die at home, most people do not. The chances that they were able to die where they preferred seem to vary according to SEP. The home deaths are coincident with social and educational resources, as well as lifestyle and family solidarity.