BACKGROUND: Where people die can influence a number of indicators of the quality of dying. We aimed to describe the place of death of people with cancer and its associations with clinical, socio-demographic and healthcare supply characteristics in 14 countries. METHODS: Cross-sectional study using death certificate data for all deaths from cancer (ICD-10 codes C00-C97) in 2008 in Belgium, Canada, Czech Republic, England, France, Hungary, Italy, Mexico, the Netherlands, New Zealand, South Korea, Spain (2010), USA (2007) and Wales (N=1,355,910). Multivariable logistic regression analyses evaluated factors associated with home death within countries and differences across countries. RESULTS: Between 12% (South Korea) and 57% (Mexico) of cancer deaths occurred at home; between 26% (Netherlands, New Zealand) and 87% (South Korea) occurred in hospital. The large between-country differences in home or hospital deaths were partly explained by differences in availability of hospital- and long-term care beds and general practitioners. Haematologic rather than solid cancer (odds ratios (ORs) 1.29-3.17) and being married rather than divorced (ORs 1.17-2.54) were most consistently associated with home death across countries. CONCLUSIONS: A large country variation in the place of death can partly be explained by countries' healthcare resources. Country-specific choices regarding the organisation of end-of-life cancer care likely explain an additional part. These findings indicate the further challenge to evaluate how different specific policies can influence place of death patterns.

Cambia Palliative Care Center of Excellence University of Washington Division of Geriatric Medicine Box 359765 401 Broadway Suite 5123 11 Seattle WA 98122 USA

Center for Palliative Care Michelska 1 7 Prague 140 00 Czech Republic

Department of Family Medicine and Chronic Care End of Life Care Research Group Vrije Universiteit Brussel and Ghent University Laarbeeklaan 103 1090 Brussels Belgium

Department of General Internal Medicine MD Anderson Cancer Center The University of Texas Houston 515 Holcombe Blvd Houston TX 77030 USA

Department of Health Science Dongduk Women's University 23 1 Hawolgok dong Seongbuk gu Seoul South Korea

Department of Medical Oncology Ghent University Hospital De Pintelaan 185 Building 6K12E 9000 Ghent Belgium

Department of Public and Occupational Health EMGO Institute for Health and Care Research VU University Medical Center Van der Boechorststraat 7 1081 BT Amsterdam The Netherlands

Faculty of Health Sciences University of Southampton 104 Burgess Road Southampton SO17 1BJ Hampshire UK

Faculty of Nursing University of Alberta 11405 87 Avenue Edmonton Alberta T6G 1C9 Canada

French National Observatory on End of Life Care 35 Rue du Plateau 75952 Paris CEDEX 19 France

Hospice Waikato 334 Cobham Drive Hillcrest Hamilton 3216 New Zealand

Information and Evaluation Service Regional Ministry of Health in Andalusia Av Innovación s n Edificio Arenas 1 41071 Seville Spain

ISPO Cancer Prevention and Research Institute Clinical Epidemiology Unit Via Oblate 2 Pal 28 A 50142 Florence Italy

University of Pécs Medical School 48 as tér 1 7622 Pécs Hungary

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