Review Finds Wide Cross-Country Variation in Place of Death

Researchers searched six bibliographic databases and grey literature for comparative death-certificate studies from at least two countries. The systematic review included 19 studies covering 68,433 to 100 million deaths recorded between 1957 and 2021 across 72 countries, including 27 low- and middle-income countries. Study quality was assessed using the Newcastle-Ottawa Scale, and results were synthesised narratively.

Hospital or health-institution deaths were examined in 17 studies across 60 countries, with reported proportions ranging from 11% in Albania to 87% in Taiwan. Home deaths were examined in 12 studies across 62 countries and ranged from 11% in Malta to 83% in Uganda. The oldest age groups were generally more likely to die at home or in long-term care facilities. Findings for sex or gender were inconsistent. Cancer was associated with lower odds of death in long-term care and higher odds of death in palliative care or hospice settings; reported relative risks for the latter ranged from 2.5 to 32.

Country differences remained after adjustment for individual characteristics and healthcare-resource availability. The authors note substantial heterogeneity in classifications and fewer studies examining long-term care and hospice deaths. They suggest internationally harmonised classifications could improve health monitoring and future research. The review describes patterns in recorded deaths and does not establish why those differences occur.