Dying in hospital: a study of incidence and factors related to hospital death using death certificate data

Background: Most people prefer not to die in a hospital, and for those with palliative care needs, doing so may result in inappropriate care and poor outcomes. We examined place of death and factors associated with hospital death in a population eligible for palliative care. Methods: We used death certificate data to identify deaths from conditions eligible for palliative care and to examine place of death and demographic, socioeconomic and environmental characteristics associated with hospital death in Belgium in 2008. Results: Of all people eligible for palliative care (N= 44 229, i.e. 43.5% of all deaths), 51% died in hospital, 25% at home and 24% in long-term care settings. Of those officially living at home at the time of death, hospital death occurred in > 60%; of those living in long-term care settings, this was 16%. Nine percent of those living at home alone at the time of death died in long-term care settings; of those living with others, this was 5%. In both, those living at home and those living in long-term care settings, hospital death was more likely in areas with higher availability of hospital beds and less likely in areas with higher availability of skilled nursing beds in long-term care settings. Conclusions: Hospital death is still common among those eligible for palliative care. The significant proportion of people living at home and dying in long-term care settings indicates the need for additional inpatient beds for terminal care in palliative care institutions.