The rise of home death in the COVID-19 pandemic: a population-based study of death certificate data for adults from 32 countries, 2012-2021.

Publication date: Feb 01, 2024

During the coronavirus 2019 disease (COVID-19) pandemic, health systems had to respond to the needs of COVID-19 patients, while caring for patients with other life-threatening conditions. Pandemics, such as the COVID-19 pandemic, stir global health and mortality patterns. This is likely to include trends in dying places. In this paper, we examine trends in place of death for adults in 32 countries, comparing the initial COVID-19 pandemic years (2020-2021) with the eight years before the pandemic (2012-2019). Data on place of death for all adults (18 years and over) that died from 1 January 2012 to 31 December 2021 were requested (47 countries approached, 32 included). The classification of place of death varied widely between countries. “Home” was the most common category, the remaining category groups comprised “hospital or health institution”, “other defined”, and “ill-defined”. We analysed place of death data in an aggregate form, by sex, age group, and selected underlying causes of death (cancer, dementia, and COVID-19). The study included 100. 7 million people (51. 5% male, 68. 0% with ≥70 years), 20. 4% died from cancer and 5. 8% from dementia; 30. 8% of deaths took place at home. The percentage of home deaths rose from 30. 1% in 2012-2013 to 30. 9% in 2018-2019 and further to 32. 2% in the pandemic (2020-2021). Home deaths increased during the pandemic in 23 countries. In most countries the rise was greater in women and cancer; age differences were not consistent. Our study shows that there was a rise in home deaths during the pandemic, but with variability across countries, sex, age, and causes of death. The sex difference observed in most countries may have several explanations, including more engagement of women in discussions about end of life care planning and hospital admission avoidance. A higher rise of home deaths among people dying of cancer may be explained by the more predictable disease trajectory compared to non-malignant conditions, as well as earlier and better integrated palliative care. This work is part of the EOLinPLACE Project, which has received funding from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (grant agreement No 948609).

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Concepts Keywords
Cancer Adult
Deaths COVID-19
December Death certificates
Mortality
Palliative care

Semantics

Type Source Name
disease MESH death
disease MESH COVID-19 pandemic
disease VO population
disease MESH causes of death
disease MESH cancer
disease MESH dementia
drug DRUGBANK Tropicamide
drug DRUGBANK Coenzyme M
pathway REACTOME Translation
disease IDO site
disease MESH pneumonia
disease IDO country
disease VO time
disease MESH infection
disease IDO symptom
disease MESH uncertainty
drug DRUGBANK Etoperidone
disease IDO history
disease VO USA
disease VO Canada
disease MESH emergency
disease VO Pla
disease VO frequency
disease VO publication
disease VO age
disease MESH Noncommunicable Diseases
disease IDO facility
disease VO protocol
disease VO organization

Original Article

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