Factors affecting place of death in Western Australia.

Despite the growing international interest in place of death and its relationship to healthcare policy, virtually nothing is known about where people die in Australia. To address this gap our study employs a longitudinal, population-based retrospective cohort study of people who died in Western Australia over a 30-month period. Mortality, morbidity and palliative care service data sets from the Western Australian Data Linkage System were examined to provide demographic and disease-specific characteristics and healthcare service use in the last year of life for the 26882 people who died during this time. The main outcome variables of the study were accommodation setting at the time of death (usual place of residence, hospital, hospice, residential aged care facility and other) and specialist palliative care use (hospital, home-based, both or neither). Over half of Western Australians died in hospital, but as people age there is an increasing tendency to die in their usual place of residence, which may be a private residence or an aged care facility. People who accessed community-based specialist palliative care had a seven times higher chance of dying in their usual place of residence. Importantly, this information is provided, not just for cancer deaths, as has been the practice to date, but for a range of other painful and life-limiting conditions considered amenable to palliative care. The unique population data on palliative care service use, made possible by the data linkage system, provides a basis for planning health services and policies.