International study reveals increase in deaths at home during the COVID-19 pandemic in 23 countries

The percentage of people dying at home has increased in 23 countries during the COVID-19 pandemic, according to an international study led by our team that analysed data from 32 countries.

02 january, 2024≈ 4 min read

The study "The rise of home death in the COVID-19 pandemic: a population-based study of death certificate data for adults from 32 countries, 2012-2021", published in the prestigious journal 'eClinicalMedicine' published by 'The Lancet', is now available. Data on the deaths of 100.7 million adults (aged 18 and over) in 32 countries was analysed.

The research team, which included members of the EOLinPLACE project and collaborating researchers from the Vrije Universiteit Brussel and the Makerere College of Health Sciences, studied trends in place of death by comparing the first years of the COVID-19 pandemic (2020-2021) with the previous eight years (2012-2019).

In the countries studied, the proportion of deaths occurring at home increased from 30.1 per cent in 2012-2013 to 30.9 per cent in 2018-2019, and further to 32.2 per cent during the pandemic (2020-2021). Hospitals or other health facilities and 'unknown place' (the latter accounting for 11.1 per cent of deaths) were included in the place of death categories considered in the survey. Data on the place of death of all deceased persons was analysed for the entire deceased population by sex, age group and selected underlying causes of death (with a focus on cancer, dementia and COVID-19).

Bárbara Gomes and Sílvia Lopes reveal that in all the countries surveyed, "68 per cent of the deceased were over seventy, 20.4 per cent of whom died from cancer and 5.8 per cent from dementia. 30.8 per cent of deaths occurred at home". The percentage of deaths at home increased during the pandemic in 23 countries, in descending order: Cyprus, United Kingdom, Malta, Poland, Lithuania, Slovenia, Spain, United States of America, Republic of Korea, Denmark, Mexico, Sweden, Estonia, Luxembourg, Slovakia, Czech Republic, Latvia, Netherlands, Italy, Greece, Croatia, Austria and Belgium.

Regarding the relevance of the study, the researchers say: "If the change we have found to dying at home is adequately supported, aligned with preferences and associated with good results, such as improved symptom control and quality of life for both the patient and their family, we are on the right track in the face of a complex health transition. If, on the other hand, there are deficits in end-of-life care, with a risk of patient and family failure, we must rethink and improve home support, considering the reallocation of resources from elsewhere". "It is crucial to consider the international and local context, considering the importance of ensuring that people with advanced illness can choose a truly viable place to spend their last days", the researchers emphasise.

They also emphasise the importance of future national and international health policies being attentive to this change, in order to "ensure that palliative and end-of-life care has adequate resources to support the growing trend of dying at home". "In the coming years, it will be crucial to monitor whether the trends we have observed are maintained or reversed between countries," emphasise Bárbara Gomes and Sílvia Lopes. "To achieve this, we need to improve the way we classify the place of death. Our team is currently developing an international classification system with more detailed and homogeneous place of death categories, which will allow for more robust comparisons between countries and better mapping of patients' preferences for where they live and receive end-of-life care", they add.