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Place of death in a small island state : a death certificate population study

Nicholas Paul Jennings (UGent) , Kenneth Chambaere (UGent) , Luc Deliens (UGent) and Joachim Cohen (UGent)
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Abstract
Objectives Low/middle-income countries, particularly Small Island Developing States, face many challenges including providing good palliative care and choice in place of care and death, but evidence of the circumstances of dying to inform policy is often lacking. This study explores where people die in Trinidad and Tobago and examines and describes the factors associated with place of death. Methods A population-level analysis of routinely collected death certificate and supplementary health data where the unit of analysis was the recorded death. We followed the Reporting of Studies Conducted Using Observational Routinely Collected Health Data reporting guidelines, an extension of Strengthening the Reporting of Observational Studies in Epidemiology, on a deidentified data set on decedents (n=10 221) extracted from International Statistical Classification of Diseases version 10 coded death records for the most recent available year, 2010. Results Of all deaths, 55.4% occurred in a government hospital and 29.7% in a private home; 65.3% occurred in people aged 60 years and older. Cardiovascular disease (23.6%), malignancies (15.5%) and diabetes mellitus (14.7%) accounted for over half of all deaths. Dying at home becomes more likely with increasing age (70-89 years (OR 1.91, 95% CI 1.73 to 2.10) and 90-highest (OR 3.63, 95% CI 3.08 to 4.27)), and less likely for people with malignancies (OR 0.85, 95% CI 0.74 to 0.97), cerebrovascular disease (OR 0.61, 95% CI 0.51 to 0.72) and respiratory disease (OR 0.74, 95% CI 0.59 to 0.91). Conclusion Place of death is influenced by age, sex, race/ethnicity, underlying cause of death and urbanisation. There is inequality between ethnic groups regarding place of care and death; availability, affordability and access to end-of-life care in different settings require attention.
Keywords
Medicine (miscellaneous), Oncology(nursing), Medical–Surgical, General Medicine, place of death, death certificates, Trinidad and Tobago, palliative care, developing country, public health, PALLIATIVE CARE, END, PREFERENCES, IMPACT, LEVEL, HOME, DIE

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MLA
Jennings, Nicholas Paul, et al. “Place of Death in a Small Island State : A Death Certificate Population Study.” BMJ SUPPORTIVE & PALLIATIVE CARE, vol. 10, no. 3, 2020, doi:10.1136/bmjspcare-2018-001631.
APA
Jennings, N. P., Chambaere, K., Deliens, L., & Cohen, J. (2020). Place of death in a small island state : a death certificate population study. BMJ SUPPORTIVE & PALLIATIVE CARE, 10(3). https://doi.org/10.1136/bmjspcare-2018-001631
Chicago author-date
Jennings, Nicholas Paul, Kenneth Chambaere, Luc Deliens, and Joachim Cohen. 2020. “Place of Death in a Small Island State : A Death Certificate Population Study.” BMJ SUPPORTIVE & PALLIATIVE CARE 10 (3). https://doi.org/10.1136/bmjspcare-2018-001631.
Chicago author-date (all authors)
Jennings, Nicholas Paul, Kenneth Chambaere, Luc Deliens, and Joachim Cohen. 2020. “Place of Death in a Small Island State : A Death Certificate Population Study.” BMJ SUPPORTIVE & PALLIATIVE CARE 10 (3). doi:10.1136/bmjspcare-2018-001631.
Vancouver
1.
Jennings NP, Chambaere K, Deliens L, Cohen J. Place of death in a small island state : a death certificate population study. BMJ SUPPORTIVE & PALLIATIVE CARE. 2020;10(3).
IEEE
[1]
N. P. Jennings, K. Chambaere, L. Deliens, and J. Cohen, “Place of death in a small island state : a death certificate population study,” BMJ SUPPORTIVE & PALLIATIVE CARE, vol. 10, no. 3, 2020.
@article{8591750,
  abstract     = {Objectives Low/middle-income countries, particularly Small Island Developing States, face many challenges including providing good palliative care and choice in place of care and death, but evidence of the circumstances of dying to inform policy is often lacking. This study explores where people die in Trinidad and Tobago and examines and describes the factors associated with place of death. Methods A population-level analysis of routinely collected death certificate and supplementary health data where the unit of analysis was the recorded death. We followed the Reporting of Studies Conducted Using Observational Routinely Collected Health Data reporting guidelines, an extension of Strengthening the Reporting of Observational Studies in Epidemiology, on a deidentified data set on decedents (n=10 221) extracted from International Statistical Classification of Diseases version 10 coded death records for the most recent available year, 2010. Results Of all deaths, 55.4% occurred in a government hospital and 29.7% in a private home; 65.3% occurred in people aged 60 years and older. Cardiovascular disease (23.6%), malignancies (15.5%) and diabetes mellitus (14.7%) accounted for over half of all deaths. Dying at home becomes more likely with increasing age (70-89 years (OR 1.91, 95% CI 1.73 to 2.10) and 90-highest (OR 3.63, 95% CI 3.08 to 4.27)), and less likely for people with malignancies (OR 0.85, 95% CI 0.74 to 0.97), cerebrovascular disease (OR 0.61, 95% CI 0.51 to 0.72) and respiratory disease (OR 0.74, 95% CI 0.59 to 0.91). Conclusion Place of death is influenced by age, sex, race/ethnicity, underlying cause of death and urbanisation. There is inequality between ethnic groups regarding place of care and death; availability, affordability and access to end-of-life care in different settings require attention.},
  articleno    = {e30},
  author       = {Jennings, Nicholas Paul and Chambaere, Kenneth and Deliens, Luc and Cohen, Joachim},
  issn         = {2045-435X},
  journal      = {BMJ SUPPORTIVE & PALLIATIVE CARE},
  keywords     = {Medicine (miscellaneous),Oncology(nursing),Medical–Surgical,General Medicine,place of death,death certificates,Trinidad and Tobago,palliative care,developing country,public health,PALLIATIVE CARE,END,PREFERENCES,IMPACT,LEVEL,HOME,DIE},
  language     = {eng},
  number       = {3},
  pages        = {8},
  title        = {Place of death in a small island state : a death certificate population study},
  url          = {http://dx.doi.org/10.1136/bmjspcare-2018-001631},
  volume       = {10},
  year         = {2020},
}

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