Study in 32 countries shows a rise in home deaths during the COVID-19 pandemic
16th January 2024
Home has always been a relevant dying place globally. This is where most patients with life-threatening conditions wish to be cared for and to die. However, decisions are shaped by a combination of illness-related, individual and environmental factors. The COVID-19 pandemic may have altered this, due to the profound impact it has had on societies and care and how healthcare services are organised.
For this study, researchers looked at data on place of death for all adults (18 years and over) that died from 2012 to 2021 in 32 countries. The classification of place of death varied widely between countries, but “home” was the most consistent category. Place of death was analysed by sex, age group and selected underlying causes of death (with a focus on cancer, dementia and COVID-19).
Of 100.7 million people deceased in 2012-21 in 32 countries 32% died at home during pandemic years, which represented a rise in usual place of death in 23 countries. In most countries the rise was greater in cancer and women. The rise in home deaths was the highest in cancer in 20 countries, and the highest in women in 17 countries.
This is the largest study of international time trends in place of death to date and the first showing a rise of home death in COVID-19 pandemic across countries. The findings matter because they signal a critical shift not seen before in end-of-life care globally, towards dying at home. Policy initiatives are needed to ensure that palliative and end-of-life care resources are appropriately allocated to support the growing trend of home death.
If the shift towards dying at home is adequately supported, aligned with preferences and associated with good outcomes, countries are on the right track facing a complex health transition. If, on the other hand, deficits in end of life care are found, with the risk of failing patients and families, policy makers must rethink and improve home support, considering reallocation of resources from other places.
To help monitor these trends, an international classification of place of death is now in development.
The study was funded by the European Research Council in the context of the EOLinPLACE Project,
led by a research team at the University of Coimbra, Portugal. www.eolinplace.com @EOLinPLACE
Lopes S, Bruno de Sousa A, Delalibera M, Namukwaya E, Cohen J, Gomes B. 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.eClinicalMedicine, Volume 0, Issue 0, 102399. Published in Lancet’s eClinicalMedicine https://doi.org/10.1016/j.eclinm.2023.102399