Yale University School of Nursing, New Haven, Connecticut 06536-0740, USA.
Palliat Support Care. 2010 Jun;8(2):177-85. doi: 10.1017/S1478951509990939. Epub 2010 Mar 23.
There is an emerging body of research aimed at understanding the determinants of place of death, as where people die may influence the quality of their death. However, little is known about place of death for people of Southern Africa. This study describes place of death (home or hospital) and potential influencing factors (cause of death, age, gender, occupation, and district of residence).
We collected the death records for years 2005 and 2006 for all adult non-traumatic deaths that occurred in Botswana, described them, and looked for associations using bivariate and multivariate analyses.
The evaluable sample consisted of 18,869 death records. Home deaths accounted for 36% of all deaths, and were predominantly listed with "unknown" cause (82.3%). Causes of death for hospital deaths were HIV/AIDS (49.7%), cardiovascular disease (13.8%), and cancer (6.6%). The mean age at the time of all deaths was 53.2 years (SD = 20.9); with 61 years (SD = 22.5) for home deaths and 48.8 years (SD = 18.6) for hospital deaths (p < .001). Logistic regression analysis revealed the following independent predictors of dying at home: unknown cause of death; female gender; >80 years of age; and residing in a city or rural area (p < .05).
A major limitation of this study was documentation of cause of death; the majority of people who died at home were listed with an unknown cause of death. This finding impeded the ability of the study to determine whether cause of death influenced dying at home. Future study is needed to determine whether verbal autopsies would increase death-certificate listings of causes of home deaths. These data would help direct end-of-life care for patients in the home.
越来越多的研究旨在了解死亡地点的决定因素，因为人们死亡的地点可能会影响他们死亡的质量。然而，对于南非南部地区的人来说，他们的死亡地点却鲜为人知。本研究描述了死亡地点（家中或医院）和潜在的影响因素（死因、年龄、性别、职业和居住地区）。
我们收集了博茨瓦纳 2005 年和 2006 年所有非创伤性成人死亡的死亡记录，对其进行了描述，并使用双变量和多变量分析寻找关联。
可评估的样本包括 18869 份死亡记录。家中死亡占所有死亡人数的 36%，主要死因不详（82.3%）。医院死亡的死因主要为艾滋病毒/艾滋病（49.7%）、心血管疾病（13.8%）和癌症（6.6%）。所有死亡的平均年龄为 53.2 岁（标准差=20.9）；家中死亡的平均年龄为 61 岁（标准差=22.5），医院死亡的平均年龄为 48.8 岁（标准差=18.6）（p<.001）。逻辑回归分析显示，在家中死亡的独立预测因素如下：死因不详；女性；年龄>80 岁；居住在城市或农村（p<.05）。
本研究的主要局限性是死因的记录；在家中死亡的大多数人被列为死因不详。这一发现阻碍了本研究确定死因是否影响在家中死亡的能力。需要进一步研究以确定口头尸检是否会增加在家中死亡的死因的死亡证明记录。这些数据将有助于指导在家中进行临终关怀。
