Factors associated with place of death of cancer patients in the Mexico City Metropolitan area

Objective: To improve the care of cancer patients by understanding the factors associated with the place of death. Patients and methods: We conducted a retrospective study of death certificates registered in Mexico during 2003. Adult cases were included if the underlying cause of death was cancer, death location was in the Mexico City Metropolitan Area (MCMA), and information was available on sociodemographic characteristics and place of death (home or medical unit). Main results: Of the 10,561 cases meeting the inclusion criteria, 54% died at home. More women (55%) than men died of cancer and at a younger age (63 vs 64 years, respectively; p < 0.001). Multivariate analysis indicated that patients diagnosed with leukemia and lymphoma were 3.6 times more likely to die in hospitals than patients diagnosed with other cancers (p < 0.001). Compared with patients who died at home, patients who died in hospitals were significantly more educated, younger, and residents of counties with more hospital beds density (p < 0.001, p < 0.001, and p = 0.003, respectively). Certificates for in-hospital deaths were more likely to be signed by other physician or health professional than were those for at-home deaths (p < 0.001). Cases with usual residency located outside the study area were 27 times more likely to die in hospitals than were metropolitan-area residents (p < 0.001). Conclusions: Patients dying at home tended to be of older age, less educated, diagnosed with prostate, urinary tract or gastrointestinal cancers, and residents of the MCMA. Health planners should consider determinants of place of death when allocating hospital or home-based palliative care units.