Division of Palliative Care, Department of Family Medicine, University of British Columbia, Vancouver, BC, Canada.
BMC Palliat Care. 2013 May 1;12:19. doi: 10.1186/1472-684X-12-19.
As Canada's population ages, the location of end of life care (whether at home, extended care facility or hospital) may change depending on the location of death. We carried out a study to identify determinants of the place of death.
Data on deaths in British Columbia between 2004 and 2008 were obtained from the Vital Statistics Agency. Place of death was categorized into home, extended care facility, hospital or other. Logistic regression analyses were used to estimate the effects of age, sex, marital status, residence, place of birth and cause of death on place of death using adjusted odds ratios and 95% confidence intervals (95% CI).
Of the 153,111 deaths in the study, 16.5% occurred at home, 29.0% in extended care, 51.0% in hospital and 3.5% occurred elsewhere. Male deaths were less likely to occur in extended care as compared with female deaths (odds ratio 0.73, 95% CI 0.71-0.75). Age (odds ratio 3.31, 95% CI 3.19-3.45 for those for ≥90 vs 70-79 years), marital status (odds ratio 1.42, 95% CI 1.38-1.47 widowed vs married), residence (odds ratio 0.80, 95% CI 0.76-0.83 rural vs Vancouver), place of birth (odds ratio 0.80, 95% CI 0.75-0.86 China vs Canada) and cause of death (odds ratio 3.91, 95% CI 3.69-4.13 dementia vs cancer) were also associated with death in extended care.
Information on determinants of place of death can inform public health policy regarding care at the end of life and make resource allocation more efficient.
随着加拿大人口老龄化，临终关怀的地点（无论是在家中、长期护理机构还是医院）可能会因死亡地点而改变。我们进行了一项研究，以确定死亡地点的决定因素。
从生命统计署获得了 2004 年至 2008 年不列颠哥伦比亚省的死亡数据。将死亡地点分为家庭、长期护理机构、医院或其他。使用调整后的优势比和 95%置信区间（95%CI），使用逻辑回归分析来估计年龄、性别、婚姻状况、居住地、出生地和死因对死亡地点的影响。
在研究中，153111 例死亡中，16.5%发生在家中，29.0%发生在长期护理机构，51.0%发生在医院，3.5%发生在其他地方。与女性死亡相比，男性死亡在长期护理机构中不太可能发生（优势比 0.73，95%CI 0.71-0.75）。年龄（≥90 岁与 70-79 岁相比的优势比 3.31，95%CI 3.19-3.45）、婚姻状况（丧偶与已婚相比的优势比 1.42，95%CI 1.38-1.47）、居住地（农村与温哥华相比的优势比 0.80，95%CI 0.76-0.83）、出生地（中国与加拿大相比的优势比 0.80，95%CI 0.75-0.86）和死因（痴呆与癌症相比的优势比 3.91，95%CI 3.69-4.13）也与长期护理机构中的死亡有关。
关于死亡地点决定因素的信息可以为临终关怀的公共卫生政策提供信息，并使资源分配更加高效。
