Skip to main content
SpringerLink
Log in

Where do people die? An international comparison of the percentage of deaths occurring in hospital and residential aged care settings in 45 populations, using published and available statistics

  • Original Article
  • Published:
International Journal of Public Health

An Erratum to this article was published on 13 October 2012

Abstract

Objective

Place of death, specifically the percentage who die in hospital or residential aged care, is largely unreported. This paper presents a cross-national comparison of location of death information from published reports and available data.

Methods

Reports of deaths occurring in hospitals, residential aged care facilities, and other locations for periods since 2001 were compiled.

Results

Over 16 million deaths are reported in 45 populations. Half reported 54 % or more of all deaths occurred in hospitals, ranging from Japan (78 %) to China (20 %). Of 21 populations reporting deaths of older people, a median of 18 % died in residential aged care, with percentages doubling with each 10-year increase in age, and 40 % higher among women.

Conclusions

This place of death study includes more populations than any other known. In many populations, residential aged care was an important site of death for older people, indicating the need to optimise models of end-of-life care in this setting. For many countries, more standardised reporting of place of death would inform policies and planning of services to support end-of-life care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  • ABS (Australian Bureau of Statistics) (2010) Deaths, Australia, 2009. Australian Bureau of Statistics, Canberra. http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/3302.02008?OpenDocument

  • Ahmad S, O’Mahony MS (2005) Where older people die: a retrospective population-based study. QJM 98(12):865–870. doi:10.1093//138

    Article  PubMed  CAS  Google Scholar 

  • AIHW (Australian Institute of Health and Welfare) (2009) 2004–05 Australian hospital separations. AIHW, Canberra

  • AIHW (Australian Institute of Health and Welfare) (2011) 2004–05 Permanent and respite care, customised tables provided by AIHW, March 2011. AIHW, Canberra

  • Bell CL, Somogyi-Zalud E, Masaki KH (2009) Methodological review: measured and reported congruence between preferred and actual place of death. Palliat Med 23(6):482–490. doi:10.1177/0269216309106318

    Article  PubMed  CAS  Google Scholar 

  • Beng AK, Fong CW, Shum E, Goh CR, Goh KT, Chew SK (2009) Where the elderly die: the influence of socio-demographic factors and cause of death on people dying at home. Ann Acad Med Singapore 38(8):676–683

    PubMed  Google Scholar 

  • Brazil K, Howell D, Bedard M, Krueger P, Heidebrecht C (2005) Preferences for place of care and place of death among informal caregivers of the terminally ill. Palliat Med 19(6):492–499

    Article  PubMed  Google Scholar 

  • CDC (Centre for Disease Control) (2006) Worktable 307. Deaths from 39 selected causes by place of death, status of decedent when death occurred in hospital or medical center, and age: United States, 2003. National vital statistics, Centers for Disease Control and Prevention, Atlanta. http://www.cdc.gov/nchs/nvss/mortality/gmwk309.htm

  • CDC (Centre for Disease Control) (2008) Worktable 309. Deaths by place of death, age, race, and sex: United States, 2005. National vital statistics, Centers for Disease Control and Prevention, Atlanta. http://www.cdc.gov/nchs/data/dvs/Mortfinal2005_worktable_309.pdf

  • Chen Z (ed) (2008) Third national representative sample survey on causes of death. Peking Union Medical College Press, Beijing

  • Chi I, Mehta KK, Howe AL (eds) (2001) Long-term care in the 21st Century: perspectives from around the Asia-Pacific Rim. Haworth Press, New York

    Google Scholar 

  • Choi KS et al (2005) Factors influencing preferences for place of terminal care and of death among cancer patients and their families in Korea. Support Care Cancer 13(8):565–572. doi:10.1007/00520-005-0809-4

    Article  PubMed  Google Scholar 

  • Cohen J, Bilsen J, Hooft P, Deboosere P, van der Wal G, Deliens L (2006) Dying at home or in an institution: using death certificates to explore the factors associated with place of death. Health Policy 78(2–3):319–329. doi:10.1016/.2005.11.003

    Article  PubMed  Google Scholar 

  • Cohen J et al (2007) Using death certificate data to study place of death in 9 European countries: opportunities and weaknesses. BMC Public Health 7:283. doi:10.1186/1471-2458-7-283

    Article  PubMed  Google Scholar 

  • Cohen J et al (2008) Population-based study of dying in hospital in six European countries. Palliat Med 22(6):702–710. doi:10.1177/0269216308092285

    Article  PubMed  CAS  Google Scholar 

  • Cohen J, Houttekier D, Chambaere K, Bilsen J, Deliens L (2011) The use of palliative care services associated with better dying circumstances. Results from an epidemiological population-based study in the Brussels metropolitan region. J Pain Symptom Manage. doi:10.1016/2011.02.017

    Google Scholar 

  • Croatian National Institute of Public Health (2011) Place of death, Croatia. Croatian National Institute of Public Health, Zagreb

  • CSO (Central Statistics Office) (2010) Places of death by age groups 2000–2010: Ireland. Central Statistics Office, Cork

  • Cyprus Ministry of Health (2011) Deaths by place of death, 2004–2009, Cyprus. Health Monitoring Unit, Nicosia

  • Czech Statistical Office (2011) Table F.06.01 Zemřelí podle místa úmrtí, pohlaví a věku. Czech Statistical Office, Praha. http://www.czso.cz/csu/redakce.nsf/i/home

  • Davies E, Higginson IJ (eds) (2004) Better palliative care of older people. World Health Organisation (WHO), Europe

  • DEIS, Ministry of Health (2011) Locale of death, Chile 2001–2009. Department of Statistics and Information, Ministry of Health, Santiago

  • Department of Health Information and Research, Malta (2011) 2001–2007 deaths, by place of death. Department of Health Information and Research, Pieta

  • Fischer S, Bosshard G, Zellweger U, Faisst K (2004) Der Sterbeort: “Wo sterben die Menschen heute in der Schweiz?” [Place of death: “Where do people die in Switzerland nowadays?”]. Z Gerontol Geriatr 37(6):467–474. doi:10.1007/00391-004-0216-3

    Article  PubMed  CAS  Google Scholar 

  • General Medical Council (2010) Treatment and care towards the end of life: good practice in decision making. General Medical Council, London

  • Gott M, Seymour J, Bellamy G, Clark D, Ahmedzai S (2004) Older people’s views about home as a place of care at the end of life. Palliat Med 18(5):460–467

    Article  PubMed  Google Scholar 

  • Grover A (2011) Thematic study on the realization of the right to health of older persons by the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, vol A/HRC/18/37. United Nations General Assembly, Geneva

  • Gysels M, Pell C, Straus L, Pool R (2011) End of life care in sub-Saharan Africa: a systematic review of the qualitative literature. BMC Palliat Care 10(6)

  • Hagstofa Íslands | Statistics Iceland (2011) Place of death by age 1981–2009. Hagstofa Íslands | Statistics Iceland, Reykjavik

  • Hall S, Petkova H, Tsouros AD, Costantini M, Higginson IJ (eds) (2011) Palliative care for older people: better practices. World Health Organisation (WHO), Europe

  • Hashimoto H, Horiguchi H, Matsuda S (2010) Micro data analysis of medical and long-term care utilization among the elderly in Japan. Int J Environ Res Public Health 7(8):3022–3037. doi:10.3390/7083022

    Article  PubMed  Google Scholar 

  • Health Data Centre: National Institute of Public Health (2011) Deaths by place of death, Slovenia 2000–2009. National Institute of Public Health, Ljubljana

  • Higginson I (2005) End-of-life care: lessons from other nations. J Palliat Med 8(suppl 1):S-161–S-173

    Google Scholar 

  • Higginson IJ, Sen-Gupta GJ (2000) Place of care in advanced cancer: a qualitative systematic literature review of patient preferences. J Palliat Med 3(3):287–300. doi:10.1089/2000.3.287

    Article  PubMed  CAS  Google Scholar 

  • Houttekier D, Cohen J, Bilsen J, Deboosere P, Verduyckt P, Deliens L (2009) Determinants of the place of death in the Brussels metropolitan region. J Pain Symptom Manage 37(6):996–1005. doi:10.1016/2008.05.014

    Article  PubMed  Google Scholar 

  • Houttekier D, Cohen J, Van den Block L, Bossuyt N, Deliens L (2010) Involvement of palliative care services strongly predicts place of death in Belgium. J Palliat Med 13(12):1461–1468. doi:10.1089/2010.0279

    Article  PubMed  Google Scholar 

  • IBGE (Brazilian Institute of Geography and Statistics) (2010) Estatisticas do Registro Civil 2009. Instituto Brazileiro de Geografia e Estatistica, Rio de Janeiro. http://www.ibge.gov.br/home/estatistica/populacao/registrocivil/2009/tabelas_pdf/tabela2_6.pdf

  • INSEE (Institut National de la Statistique et des Études Économiques) (2010) Table 75. Deaths by place of death and age group reached during the year 2005. INSEE Resultas publication, Paris. http://www.sd2005_t75_fm.xls

  • INSEE (Institut National de la Statistique et des Études Économiques) (2011) Table 75. Deaths by place of death and age group reached during the year 2006. INSEE Resultas publication, Paris. http://www.sd2006_t75_fm.xls

  • INSTAT (Instituti I Statisitkave) (2010) Shkaqet e Vdekjeve për Vitin 2009 [Causes of Death for the Year 2009]. Instituti I Statisitkave, Tiranë, Albania, p Supplied by Director of Publication, Dr. Ines Nurja

  • Institute of Hygiene, Lithuania (2011) Deaths according to place of death by gender and age groups in Lithuania, 2010. Institute of Hygiene, Lithuania, Vilnius

  • Lazenby M, Ma T, Moffat H, Funk M, Knobf M, McCorkle R (2010) Influences on place of death in Botswana. Palliat Support Care 8:177–185

    Article  PubMed  Google Scholar 

  • Lin H-C, Lin Y-J, Liu T-C, Chen C-S, Lin C-C (2007) Urbanization and place of death for the elderly: a 10-year population-based study. Palliat Med 21:705–711

    Article  PubMed  Google Scholar 

  • Machado MdC et al (2010) From 15 to 115 years of life: mortality trends in Portugal 2000–2008. Ministry of Health, Lisbon

    Google Scholar 

  • Mathers CD, Fat DM, Inoue M, Rao C, Lopez AD (2005) Counting the dead and what they died from: an assessment of the global status of cause of death data. Bull World Health Organ 83:171–177

    PubMed  Google Scholar 

  • Menec VH, Lix L, Nowicki S, Ekuma O (2007) Health care use at the end of life among older adults: does it vary by age? J Gerontol A Biol Sci Med Sci 62(4):400–407. doi:62/4/400

    Article  PubMed  Google Scholar 

  • Ministry of Health (2011) Total number of deaths by place of death category, sex and age group, 2003–2007: New Zealand. Ministry of Health, Wellington

  • Ministry of Social Affairs of Estonia (2011) Table 2. Quality indicators, per cent of cases. Ministry of Social Affairs of Estonia, Tallinn. http://pxweb.tai.ee/esf/pxweb2008/Database_en/Population/04Deaths/SDinfo_en.htm

  • Motiwala SS, Croxford R, Guerriere DN, Coyte PC (2006) Predictors of place of death for seniors in Ontario: a population-based cohort analysis. Can J Aging 25(4):363–371

    Article  PubMed  Google Scholar 

  • National End-of-Life Care Programme (2010a) End of life care profiles, place of death intelligence network. National Health Service, Bristol. http://www.endoflifecare-intelligence.org.uk/profiles/Place_of_Death/atlas.html

  • National End-of-Life Care Programme (2010b) Variations in place of death in England. Inequalities or appropriate consequences of age, gender and cause of death? National Health Service, Bristol

  • National Statistics Center (2010) Volume 1 General mortality. Table 5.5 Trends in deaths by place of occurrence: Japan. National Statistics Center, e-Stat. http://www.e-stat.go.jp/SG1/estat/ListE.do?lid=000001066473

  • Q: Statistick Austria (2011) Vital statistics. Q: Statistick Austria, Vienna

  • Ruiz-Ramos M, Javier Garcis-Leon F, Mendez-Martinez C (2011) Place of death in Andulasia: influence of age, gender and cause of death. Revista Clinica Espanola 211(3):127–132

  • Seale C (2000) Changing patterns of death and dying. Soc Sci Med 51(6):917–930 pii:S027795360000071

    Article  PubMed  CAS  Google Scholar 

  • Statistical Office of the Republic of Serbia (2010) Statistical Yearbook of Serbia 2010. Statistical Office of the Republic of Serbia, Belgrade. http://www.god2010.zip

  • Statistics Korea (2010) Korea MicroData Service Systems (KMDSS): cause of death statistics, 2009. Statistics Korea. http://mdss.kostat.go.kr. Accessed June 2011

  • Statistics South Africa (2005) Mortality and causes of death in South Africa, 2005: findings from death notification. Statistics South Africa, Pretoria. http://www.statssa.gov.za/publications/P03093/P030932005.pdf. Accessed January 2011

  • Statistisk sentralbyrå | Statistics Norway (2010) Deaths, by place of death, time and contents. Statistics Norway, Oslo

  • Taiwan DoH (2008) Cause of death statistics. Department of Health, Taiwan. http://www.doh.gov.tw/EN2006/DM/DM2_p01.aspx?class_no=390&now_fod_list_no=10864&level_no=2&doc_no=75601

  • Takezako Y, Tamiya N, Kajii E (2007) The nursing home versus the hospital as the place of dying for nursing home residents in Japan. Health Policy 81(2–3):280–288. doi:10.1016/2006.06.008

    Article  PubMed  Google Scholar 

  • UK Statistics Authority (2009) Mortality statistics: deaths registered in 2008. Review of the National Statistician on deaths in England and Wales. Office for National Statistics, Newport

  • United Nations Department of Economic and Social Affairs SD (2001) Principles and recommendations for a vital statistics system, Revision 2. United Nations, New York

  • Wilson DM et al (2009) The rapidly changing location of death in Canada, 1994–2004. Soc Sci Med 68(10):1752–1758. doi:10.1016/2009.03.006

    Article  PubMed  Google Scholar 

  • Yun YH, Lim MK, Choi KS, Rhee YS (2006) Predictors associated with the place of death in a country with increasing hospital deaths. Palliat Med 20(4):455–461

    Article  PubMed  Google Scholar 

  • Zhan HJ, Feng ZL, Chen ZY, Feng XT (2011) The role of the family in institutional long-term care: cultural management of filial piety in China. Int J Soc Welf 20:S121–S134. doi:10.1111/1468-2397.2011.00808

    Article  Google Scholar 

Download references

Acknowledgments

We are extremely appreciative to the generous and helpful staffs of official information departments and ministries who have cooperated in providing information in emails, tables and online databases. We also acknowledge academics that assisted in sourcing data, including Dr. Silmara Gusso at the University of Auckland, New Zealand, and Dr. Heidy Leiva, Rancagua Regional Hospital, Chile. With one exception, all data were obtained without charge. We are also particularly grateful to Ann Peut also at AIHW, Canberra, who provided very valuable comments and assistance on several drafts of this paper. The Freemasons’ Department of Geriatric Medicine at the University of Auckland is supported by longstanding endowments and grants from Freemasons New Zealand and the Freemasons’ Roskill Foundation. Joanna Broad’s appointment is supported by grant 10/373 from the Health Research Council of New Zealand.

Author information

Authors and Affiliations

  1. Freemasons’ Department of Geriatric Medicine, University of Auckland, C/-WDHB, Private Bag 93503, Takapuna, Auckland, 0740, New Zealand

    Joanna B. Broad, Michal Boyd & Martin J. Connolly

  2. School of Nursing, University of Auckland, Auckland, New Zealand

    Merryn Gott

  3. Graduate School of Public Health, Institute of Health and Environment, Seoul National University, Seoul, Korea

    Hongsoo Kim

  4. Institute of Population Research, Peking University, Beijing, China

    He Chen

Authors
  1. Joanna B. Broad
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Merryn Gott
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hongsoo Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michal Boyd
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. He Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Martin J. Connolly
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joanna B. Broad.

Appendix: Sources of population data

Appendix: Sources of population data

 

 

Population and years reported

Total number of deaths in period

Number of deaths in people aged 65+ years (if stated)

Restrictions

Source of data: paper = academic paper, report = published report, database = access to electronic database, by request = table/data provided on request

Data source or reference

1

Albania 2009

15,662

 

–

By request

INSTAT (Instituti I Statisitkave) (2010)

2

Australia 2005

131,595

104,443

–

By request

ABS (Australian Bureau of Statistics) (2010), AIHW (Australian Institute of Health and Welfare) (2009, 2011)

3

Austria 2009–10

154,580

127,289

–

By request

Q: Statistick Austria (2011)

4

Belgium (Flanders) 2003

57,156

 

–

Paper

Cohen et al. (2006)

5

Belgium (Flanders) 2001

55,759

46,271

–

Paper

Cohen et al. (2008)

6

Belgium 2005–07

195,612

 

Aged 1 year or older

Paper

Houttekier et al. (2010)

7

Botswana 2005–06

18,869

 

Non-traumatic deaths only

Paper

Lazenby et al. (2010)

8

Brazil 2009

1,083,399

 

–

Database

IBGE (Brazilian Institute of Geography and Statistics) (2010)

9

Canada 2004

171,094

 

–

Paper

Wilson et al. (2009)

10

Chile 2007–09

275,133

 

–

By request

DEIS, Ministry of Health (2011)

11

China 2004–05

868,484

 

Surveillance of 158 counties

Report

Chen (2008)

12

Croatia 2009

52,414

41,363

–

By request

Croatian National Institute of Public Health (2011)

13

Cyprus 2007–09

15,757

12,678

–

By request

Cyprus Ministry of Health (2011)

14

Czech Republic 2009

107,421

81,835

–

Database

Czech Statistical Office (2011)

15

England and Wales 2008

509,090

421,074

–

Report

National End-of-Life Care Programme (2010b)

16

England 2005–07

474,719

392,785

–

Database

UK Statistics Authority (2009)

17

England 2007–09

Not stated

 

–

Database

National End-of-Life Care Programme (2010a)

18

Estonia 2008–10

28,708

 

–

By request

Ministry of Social Affairs of Estonia (2011)

19

France 2005–06

1,043,949

833,366

–

Database

INSEE (Institut National de la Statistique et des Études Économiques) (2010, 2011)

20

Iceland 2007–09

5,932

4,875

–

By request

Hagstofa Íslands | Statistics Iceland (2011)

21

Ireland 2000–10

318,184

248,016

–

By request

CSO (Central Statistics Office) (2010)

22

Japan 2007–09

3,392,606

 

–

Database

National Statistics Center (2010)

23

Korea 2009

246,942

169,902

–

Database

Statistics Korea (2010)

24

Lithuania 2010

42,120

 

–

By request

Institute of Hygiene, Lithuania (2011)

25

Malta 2001–10

31,294

25,050

–

By request

Department of Health Information and Research, Malta (2011)

26

Netherlands 2003

141,936

 

–

Paper

Cohen et al. (2008)

27

New Zealand 2003–07

140,836

140,836

–

By request

Ministry of Health (2011)

28

Norway 2009

41,342

 

–

Database

Statistisk sentralbyrå | Statistics Norway (2010)

29

Portugal (15+ years) 2008

98,840

 

Aged over 15 years

Report

Machado et al. (2010)

30

Scotland 2003

58,473

 

–

Paper

Cohen et al. (2008)

31

Serbia 2006–09

412,400

 

–

Database

Statistical Office of the Republic of Serbia (2010)

32

Slovenia 2005–09

92,647

 

–

By request

Health Data Centre: National Institute of Public Health (2011)

33

South Africa 2005

591,213

 

–

Database

Statistics South Africa (2005)

34

Spain (Andulasia) 2009

31,463

 

–

Paper

Ruiz-Ramos et al. (2011)

35

Sweden 2002

95,064

 

–

Paper

Cohen et al. (2008)

36

Switzerland (German) 2001

3,358

 

Aged over 1 year

Paper

Fischer et al. (2004)

37

Taiwan 2008

142,283

 

–

Database

Taiwan (2008)

38

USA 2003

2,452,154

1,806,070

–

Database

CDC (Centre for Disease Control) (2006)

39

USA 2005

2,452,506

1,790,062

–

Database

CDC (Centre for Disease Control) (2008)

40

Wales 2003

33,810

 

–

Paper

Cohen et al. (2008)

41

Canada (Manitoba) 2000

–

7,678

Aged over 65 years

Paper

Menec et al. (2007)

42

Canada (Ontario) 2002

–

58,689

Aged over 66 years

Paper

Motiwala et al. (2006)

43

Japan (Kyushu) 2000–04

–

50,857

Aged over 65 years

Paper

Hashimoto et al. (2010)

44

Singapore 2006

–

10,399

Aged over 65 years

Paper

Beng et al. (2009)

45

Wales 2001

–

27,532

Aged over 65 years

Paper

Ahmad and O’Mahony (2005)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Broad, J.B., Gott, M., Kim, H. et al. Where do people die? An international comparison of the percentage of deaths occurring in hospital and residential aged care settings in 45 populations, using published and available statistics. Int J Public Health 58, 257–267 (2013). https://doi.org/10.1007/s00038-012-0394-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00038-012-0394-5

Keywords

Search

Navigation