BACKGROUND: Studying where people die across countries can serve as an evidence base for health policy on end-of-life care. This study describes the place of death of people who died from diseases indicative of palliative care need in 14 countries, the association of place of death with cause of death, sociodemographic and healthcare availability characteristics in each country and the extent to which these characteristics explain country differences in the place of death. METHODS: Death certificate data for all deaths in 2008 (age ≥1 year) in Belgium, Canada, the Czech Republic, England, France, Hungary, Italy, Mexico, the Netherlands, New Zealand, South Korea, Spain (Andalusia), the USA and Wales caused by cancer, heart/renal/liver failure, chronic obstructive pulmonary disease, diseases of the nervous system or HIV/AIDS were linked with national or regional healthcare statistics (N=2,220,997). RESULTS: 13% (Canada) to 53% (Mexico) of people died at home and 25% (the Netherlands) to 85% (South Korea) died in hospital. The strength and direction of associations between home death and cause of death, sociodemographic and healthcare availability factors differed between countries. Differences between countries in home versus hospital death were only partly explained by differences in these factors. CONCLUSIONS: The large differences between countries in and beyond Europe in the place of death of people in potential need of palliative care are not entirely attributable to sociodemographic characteristics, cause of death or availability of healthcare resources, which suggests that countries' palliative and end-of-life care policies may influence where people die.

Brown University School of Public Health Providence Rhode Island USA

Center for Palliative Care Prague Czech Republic

Department of Family Medicine and Chronic Care End of Life Care Research Group Vrije Universiteit Brussel and Ghent University Brussels Belgium

Department of Family Medicine and Chronic Care End of Life Care Research Group Vrije Universiteit Brussel and Ghent University Brussels Belgium Department of Medical Oncology Ghent University Hospital Ghent Belgium

Dongduk Women's University Seoul South Korea

EMGO Institute for Health and Care Research VU University Medical Center Amsterdam The Netherlands

Faculty of Health Sciences University of Southampton Hampshire UK

Faculty of Nursing University of Alberta Edmonton Alberta Canada

French National Observatory on End of Life Care Paris France Aging Research Center Karolinska Institutet and Stockholm University Stockholm Sweden

Hospice Waikato Hamilton New Zealand

ISPO Cancer Prevention and Research Institute Florence Italy

Regional Ministry of Equality Health and Social Policies in Andalusia Seville Spain

The University of Texas MD Anderson Cancer Center Houston Texas USA

University of Pécs Medical School Pécs Hungary

J Epidemiol Community Health. 2016 Jan;70(1):9. doi: 10.1136/jech-2015-206362. PubMed

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