BACKGROUND: Most people prefer to receive end-of-life care in familiar surroundings rather than in hospital. This study examines variation in place of death for people dying from Parkinson's disease (PD) across 11 European and non-European countries. METHODS: Using death certificate data of 2008 for Belgium, France, Italy, Hungary, Czech Republic, New Zealand, USA, Canada, Mexico, South Korea and Spain for all deaths with PD as an underlying cause (ICD-10 code: G20) cross-national differences in place of death were examined. Associations between place of death and patient socio-demographic and regional characteristics were evaluated using multivariable binary logistic regression analyses. RESULTS: The proportion of deaths in hospital ranged from 17% in the USA to 75% in South Korea. Hospital was the most prevalent place of death in France (40%), Hungary (60%) and South Korea; nursing home in New Zealand (71%), Belgium (52%), USA (50%), Canada (48%) and Czech Republic (44%); home in Mexico (73%), Italy (51%) and Spain (46%). The chances of dying in hospital were consistently higher for men (Belgium, France, Italy, USA, Canada), those younger than 80 years (Belgium, France, Italy, USA, Mexico), and those living in areas with a higher provision of hospital beds (Italy, USA). CONCLUSIONS: In several countries a substantial proportion of deaths from PD occurs in hospitals, although this may not be the most optimal place of terminal care and death. The wide variation between countries in the proportion of deaths from PD occurring in hospital indicates a potential for many countries to reduce these proportions.

Brown University Department of Community Health Rhode Island USA

Center for Palliative Care Prague Czech Republic

Consejería de Igualdad Salud y Bienestar Social Agencia de Evaluación de Tecnologías Sanitarias de Andalucía Sevilla Spain

Department of Palliative Care King's College London Cicely Saunders Institute Policy and Rehabilitation Bessemer Road Denmark Hill London SE5 9PJ UK

Dongduk Women's University Seoul Korea

French National Observatory on End of Life Care Paris France

Hospice Waikato Hamilton New Zealand

Italian National Institute of Statistics Rome Italy

The University of Texas MD Anderson Cancer Center Houston TX USA

University of Alberta Edmonton Alberta Canada

University of Pécs Medical School Pécs Hungary

Vrije Universiteit Brussel and Ghent University End of Life Care Research Group Brussels Belgium

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