Place of death of children with complex chronic conditions: cross-national study of 11 countries

Cecilia Håkanson, Joakim Öhlén, Ulrika Kreicbergs, Marylou Cardenas-Turanzas, Donna M. Wilson, Martin Loucka, Sandra Frache, Lucia Giovannetti, Wayne Naylor, Yong Joo Rhee, Miguel Ruiz Ramos, Joan Teno, Kim Beernaert, Luc Deliens, Dirk Houttekier, Joachim Cohen

Research output: Contribution to journalArticle

12 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)327-335
Number of pages9
JournalEuropean Journal of Pediatrics
Issue number3
StatePublished - Mar 1 2017
Externally publishedYes



  • Children
  • Complex chronic conditions
  • Cross-national
  • Paediatric palliative care
  • Place of death
  • Population-level

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Håkanson, C., Öhlén, J., Kreicbergs, U., Cardenas-Turanzas, M., Wilson, D. M., Loucka, M., Frache, S., Giovannetti, L., Naylor, W., Rhee, Y. J., Ramos, M. R., Teno, J., Beernaert, K., Deliens, L., Houttekier, D., & Cohen, J. (2017). Place of death of children with complex chronic conditions: cross-national study of 11 countries. European Journal of Pediatrics, 176(3), 327-335.