TY - JOUR
T1 - Place of death of children with complex chronic conditions
T2 - cross-national study of 11 countries
AU - Håkanson, Cecilia
AU - Öhlén, Joakim
AU - Kreicbergs, Ulrika
AU - Cardenas-Turanzas, Marylou
AU - Wilson, Donna M.
AU - Loucka, Martin
AU - Frache, Sandra
AU - Giovannetti, Lucia
AU - Naylor, Wayne
AU - Rhee, Yong Joo
AU - Ramos, Miguel Ruiz
AU - Teno, Joan
AU - Beernaert, Kim
AU - Deliens, Luc
AU - Houttekier, Dirk
AU - Cohen, Joachim
N1 - Publisher Copyright:
© 2017, Springer-Verlag Berlin Heidelberg.
PY - 2017/3/1
Y1 - 2017/3/1
N2 - Cross-national understanding of place of death is crucial for health service systems for their provision of efficient and equal access to paediatric palliative care. The objectives of this population-level study were to examine where children with complex chronic conditions (CCC) die and to investigate associations between places of death and sex, cause of death and country. The study used death certificate data of all deceased 1- to 17-year-old children (n = 40,624) who died in 2008, in 11 European and non-European countries. Multivariable logistic regression was performed to determine associations between place of death and other factors. Between 24.4 and 75.3% of all children 1–17 years in the countries died of CCC. Of these, between 6.7 and 42.4% died at home. In Belgium and the USA, all deaths caused by CCC other than malignancies were less likely to occur at home, whereas in Mexico and South Korea, deaths caused by neuromuscular diseases were more likely to occur at home than malignancies. In Mexico (OR = 0.91, 95% CI: 0.83–1.00) and Sweden (OR = 0.35, 95% CI: 0.15–0.83), girls had a significantly lower chance of dying at home than boys. Conclusion: This study shows large cross-national variations in place of death. These variations may relate to health system-related infrastructures and policies, and differences in cultural values related to place of death, although this needs further investigation. The patterns found in this study can inform the development of paediatric palliative care programs internationally.What is known:• There is a scarcity of population-level studies investigating where children with CCC die in different countries.• Cross-national understanding of place of death provides information to health care systems for providing efficient and equal access to paediatric palliative care.What is new:• There are large cross-national variations in the place of death of children with CCC, with few deathsoccuring at home in some countries whereas hospital deaths are generally most common.• In general, deaths caused by neuromuscular diseases and malignancies occur at home more often thanother CCC.
AB - Cross-national understanding of place of death is crucial for health service systems for their provision of efficient and equal access to paediatric palliative care. The objectives of this population-level study were to examine where children with complex chronic conditions (CCC) die and to investigate associations between places of death and sex, cause of death and country. The study used death certificate data of all deceased 1- to 17-year-old children (n = 40,624) who died in 2008, in 11 European and non-European countries. Multivariable logistic regression was performed to determine associations between place of death and other factors. Between 24.4 and 75.3% of all children 1–17 years in the countries died of CCC. Of these, between 6.7 and 42.4% died at home. In Belgium and the USA, all deaths caused by CCC other than malignancies were less likely to occur at home, whereas in Mexico and South Korea, deaths caused by neuromuscular diseases were more likely to occur at home than malignancies. In Mexico (OR = 0.91, 95% CI: 0.83–1.00) and Sweden (OR = 0.35, 95% CI: 0.15–0.83), girls had a significantly lower chance of dying at home than boys. Conclusion: This study shows large cross-national variations in place of death. These variations may relate to health system-related infrastructures and policies, and differences in cultural values related to place of death, although this needs further investigation. The patterns found in this study can inform the development of paediatric palliative care programs internationally.What is known:• There is a scarcity of population-level studies investigating where children with CCC die in different countries.• Cross-national understanding of place of death provides information to health care systems for providing efficient and equal access to paediatric palliative care.What is new:• There are large cross-national variations in the place of death of children with CCC, with few deathsoccuring at home in some countries whereas hospital deaths are generally most common.• In general, deaths caused by neuromuscular diseases and malignancies occur at home more often thanother CCC.
KW - Children
KW - Complex chronic conditions
KW - Cross-national
KW - Paediatric palliative care
KW - Place of death
KW - Population-level
UR - http://www.scopus.com/inward/record.url?scp=85008700507&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85008700507&partnerID=8YFLogxK
U2 - 10.1007/s00431-016-2837-0
DO - 10.1007/s00431-016-2837-0
M3 - Article
C2 - 28070671
AN - SCOPUS:85008700507
SN - 0340-6199
VL - 176
SP - 327
EP - 335
JO - European Journal of Pediatrics
JF - European Journal of Pediatrics
IS - 3
ER -