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The proportion of deaths at home amongst cancer patients has increased internationally in recent years. This trend has become evident in Scotland. Underlying reasons are unclear and may include changing hospital policy decisions and changing social and demographic composition of the population.
Objectives and Approach
To assess the drivers behind increased odds of dying at home amongst people who died of cancer in Scotland between 2001 and 2011. Data from the 2001 and 2011 censuses for everyone who was living at home at enumeration to death registration data for all deaths occurring in the 12 months following census. A dataset was created of everyone whose death was indicated to be from cancer. Bivariate and multivariate analysis was test hypotheses that (1) hospital discharge, and (2) that changes in socio-economic characteristics might explain the change.
There were 12,640 deaths from cancer in the 12 months following the 2001 census, 13,167 following the 2011 census. Odds of dying at home were greater during the later period (OR 1.13). There was no evidence to suggest discharge from hospital in the days before death explained this change. Bivariate analysis demonstrated increased odds of dying at home associated with younger age, being a home owner, being married, and living with others. However, introducing these variables to logistic regression models made little difference to the changing odds of dying at home between the two census periods.
Conclusion / Implications
The lack of impact on the odds of dying at home in Scotland between the two census periods suggests either policy or improved palliative care to be behind the shift. However, the findings with regard to drivers behind place of death suggests future projections should factor in changing social and demographic composition of the population in later life to anticipate future trends in place of death.
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