Zhou Rui, Wang Shuangshuang, Yao Aaron
School of Public Administration and Human Geography, Hunan University of Technology and Bussiness, Changsha, 410205, China.
School of Public Administration, Southwest Jiaotong University, No. 111, North Section 1, Second Ring Road, Chengdu, 610031, China.
BMC Palliat Care. 2025 Jul 2;24(1):183. doi: 10.1186/s12904-025-01824-0.
Place of death has received extensive interest among scholars, but research focusing on place of death among Chinese older adults is scarce. This study aimed to explore the associations between rural/urban residence, primary income source, and place of death among Chinese older adults.
The sample consists of 24,794 decedents (female = 60%, died at home = 88%, mean age at death = 95) from the 2002-2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). Chi-squared tests and binary logistic regression models were used to analyze relationships between residential area (urban vs. town or rural), income source (financial support from family vs. personal income), and place of death (home vs. hospitals or other healthcare settings).
Decedents living in cities were 3.5 times more likely to die in hospitals or other healthcare settings than at home, and those who had personal income were 1.5 times more likely to die in healthcare settings than at home. Notably, the interaction between city and personal income were significant (P < 0.001). Older adults who both lived in cities and had personal income had the highest probability (83%) to die in healthcare settings.
Urban residence and having personal income were highly associated with dying in hospitals or other healthcare settings. As China urbanizes and expands its pension system, an increasingly higher percentage of deaths may happen in healthcare settings. This study alerts policymakers of the enormous pressures that the hospital-centered care system may face in the future. A home-based palliative care and hospice system may be needed to improve the incidence and experiences of patients dying at home.
Not applicable.
死亡地点已引起学者们的广泛关注，但针对中国老年人死亡地点的研究却很少。本研究旨在探讨中国老年人的城乡居住情况、主要收入来源与死亡地点之间的关联。
样本来自2002 - 2018年中国老年健康影响因素跟踪调查（CLHLS）的24794名死者（女性占60%，在家中死亡占88%，平均死亡年龄为95岁）。采用卡方检验和二元逻辑回归模型分析居住地区（城市与城镇或农村）、收入来源（家庭经济支持与个人收入）与死亡地点（家中与医院或其他医疗机构）之间的关系。
居住在城市的死者在医院或其他医疗机构死亡的可能性是在家中死亡的3.5倍，有个人收入的死者在医疗机构死亡的可能性是在家中死亡的1.5倍。值得注意的是，城市与个人收入之间的交互作用显著（P < 0.001）。既居住在城市又有个人收入的老年人在医疗机构死亡的概率最高（83%）。
城市居住和有个人收入与在医院或其他医疗机构死亡高度相关。随着中国城市化进程的推进和养老金制度的扩大，在医疗机构发生死亡的比例可能会越来越高。本研究提醒政策制定者，以医院为中心的医疗系统未来可能面临巨大压力。可能需要一个以家庭为基础的姑息治疗和临终关怀系统，以提高患者在家中死亡的发生率和体验。
不适用。
