• Barbara Gomes, Maria João Pinheiro, Sílvia Lopes, Maja de Brito, Vera P Sarmento, Lopes FerreiraPedroP6 Centre for Studies and Health Research of the University of Coimbra, Coimbra, Portugal.7 Faculty of Economics, University of Coimbra, Coimbra, Portugal., and Henrique Barros.
• 1 Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
• Palliat Med. 2018 Apr 1; 32 (4): 891-901.

BackgroundMost 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.AimWe examined trends and risk factors for hospital death in conditions needing palliative care in a country without integrated palliative care.DesignThis is a death certificate study. We examined factors associated with hospital death using logistic regression.Setting/ParticipantsAll 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.ResultsConditions 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.ConclusionThe 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.

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