• Frederick Burge, Beverley Lawson, and Grace Johnston.
• Department of Family Medicine, Dalhousie University, Halifax, NS. fred.burge@dal.ca
• CMAJ. 2003 Feb 4;168(3):265-70.

BackgroundAlthough many patients with cancer would prefer to die at home, most die in hospital. We carried out a study to describe the yearly trends in the place of death between 1992 and 1997 and to determine predictors of out-of-hospital death for adults with cancer in Nova Scotia.MethodsIn this population-based study, we linked administrative health data from 2 databases - the Nova Scotia Cancer Centre Oncology Patient Information System and the Queen Elizabeth II Health Sciences Centre Palliative Care Program - for all adults in Nova Scotia who died of cancer from 1992 to 1997. We also used grouped neighbourhood income information from the 1996 Canadian census. Death out of hospital was defined as death in any location other than an acute care hospital facility. We used logistic regression analysis to identify the odds of dying out of hospital over time and to identify factors predictive of out-of-hospital death.ResultsA total of 14 037 adults died of cancer during the study period. The data for 101 people were excluded because of missing information regarding place of death. Of the remaining 13 936 people, 10 266 (73.7%) died in hospital and 3670 (26.3%) died out of hospital. Over the study period the proportion of people who died out of hospital rose by 52%, from 19.8% (433/2182) in 1992 to 30.2% (713/2359) in 1997. Predictors associated with out-of-hospital death included year of death (for 1997 v. 1992, adjusted odds ratio [OR] 1.8, 95% confidence interval [CI] 1.5-2.0), female sex (adjusted OR 1.2, 95% CI 1.1-1.3), age (for > or = 85 v. 18-44 years, adjusted OR 2.2, 95% CI 1.7-2.8), length of survival (for 61-120 v. < or =60 days, adjusted OR 2.2, 95% CI 1.8-2.6; for 121-180 v. < or =60 days, adjusted OR 2.5, 95% CI 2.2-2.8), having received palliative radiation (adjusted OR 0.8, 95% CI 0.7-0.9) and region of death (Cape Breton v. Halifax, adjusted OR 0.5, 95% CI 0.5-0.6). Among Halifax residents, registration in the Palliative Care Program was also a significant predictor of out-of-hospital death (adjusted OR 1.4, 95% CI 1.2-1.7). Tumour group, neighbourhood income and residence (urban v. rural) were not predictive of out-of-hospital death in multivariate analysis.InterpretationOver time, more patients with cancer, especially women, elderly people and people with longer survival after diagnosis, died outside of hospital in Nova Scotia.

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