Health Policy 78 (2006) 319–329
Dying at home or in an institution
Using death certificates to explore the factors
associated with place of death
Joachim Cohen
a,*
, Johan Bilsen
a,b
, Peter Hooft
c,
, Patrick Deboosere
d
,
Gerrit van der Wal
e
, Luc Deliens
a,e
a
End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
b
Centre for Environmental Philosophy and Bioethics, Ghent University, Ghent, Belgium
c
Preventive and Social Heath Care Division, Ministry of Flanders, Brussels, Belgium
d
Faculty of Economic, Social and Political Sciences, Department of Social Research, Interface Demography,
Vrije Universiteit Brussel, Brussels, Belgium
e
Department of Public and Occupational Health and Institute for Research in Extramural Medicine,
VU University Medical Center, Amsterdam, the Netherlands
Abstract
Introduction: The knowledge of determinants of place of death is important for public health policy aimed at improving the
quality of end-of-life care.
Methods: We investigated the influence of clinical, socio-demographic, residential and health care system factors on the place
of death, using data from all 55,759 deaths in 2001 in Flanders (Belgium), gathered via official death certificates and data from
anonymously linked health care statistics. A multivariate logistic regression was used to examine the associated factors (home
versus hospital as dependent categories).
Results: Of all deaths in Flanders, 53.7% took place in hospital, 24.3% at home and 19.8% in a care home. The probability of
home deaths varied by region, by rural or urban residence and by the hospital bed availability in the region and dying at home
was less likely among those suffering from certain non-malignant chronic diseases, the less educated and those living alone.
Conclusion: Although most people wish to die at home, most deaths in Flanders (Belgium) in 2001 did not take place there.
The clinical, socio-demographic and residential factors found to be associated with the place of death could serve as focal points
for a policy to facilitate dying in the place of choice, including at home.
© 2005 Elsevier Ireland Ltd. All rights reserved.
Keywords: Belgium; Causes of death; Death certificates; End-of-life care; Home care; Hospital mortality; Palliative care; Place of death
*
Corresponding author. End-of-Life Care Research Group, Department of Medical Sociology and Health Sciences,
Vrije Universiteit Brussel, Laarbeeklaan 103, B-1090 Brussels, Belgium. Tel.: +32 2 477 47 14; fax: +32 2 477 47 11.
E-mail address: Joachim.Cohen@vub.ac.be (J. Cohen).
Deceased. Dr. Peter Hooft was a victim of the tsunami in Thailand on December 26, 2004. The final version of this article was completed
after his disappearance, and he was thus not able to read or approve it.
0168-8510/$ – see front matter © 2005 Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/j.healthpol.2005.11.003