Academic journal article Canadian Journal of Public Health

Proportion of Cancer Deaths Occurring in Hospital, Canada, 1994-2000

Academic journal article Canadian Journal of Public Health

Proportion of Cancer Deaths Occurring in Hospital, Canada, 1994-2000

Article excerpt


Background: Most terminally ill cancer patients would prefer not to die in hospital, but only a minority achieve their wish. Our objective was to examine the proportion of cancer deaths occurring in Canadian hospitals.

Methods: The two sources of data (1994-2000) were: 1) all hospital separations (HS) with a primary diagnosis of cancer and discharge as 'dead'; 2) all death certificates (DC) with cancer as underlying cause of death. Proportions of hospital deaths were estimated with two different numerators: 1) hospital cancer deaths from HS data, and 2) deaths with hospital as location from DC data; the denominator for both were all cancer deaths identified from the DC data.

Results: Proportions of hospital deaths from HS data decreased from 55% to 40% over 1994-2000, was slightly lower for females, decreased with age, but varied widely among provinces. Proportions of hospital deaths from DC data started at 80% and showed a small downward trend over the years. While age, sex, and cancer site distributions stayed the same, the proportion of hospital deaths from DC date again varied among provinces. For provinces with the home category completed on the DC data, 1999-2000, Alberta had most home deaths at 15.6% and PEI least at 5.7%.

Interpretation: This is the first Canada-wide data on place of death for terminal cancer, which is important for determining and comparing present-day practices, as well as for planning for the future.

MeSH terms: Neoplasms; death; hospital; home

Nearly half of palliative care patients and most terminally ill cancer patients prefer not to die in hospital, yet only a minority achieve their wish.1-4 Indications are that the disparity between desired and actual place of death is changing. Cancer deaths occurring in acute care hospitals declined by nearly 10% from 1992 to 1997 in Nova Scotia.5 Prior to the 1992/1993 implementation of a palliative care program in Edmonton, 86% of cancer deaths occurred in acute care hospitals, but diree years later, this had dropped to 49%.6 Abroad, the proportion of in-hospital deaths varied from 63% in Australia in 1993,7 to 42% in Ireland in 1997,8 with studies in the United States (US), Europe, and Australia closer to 50%.9-11 Within their own context, most study populations show decreasing trends in hospital deaths.7,10-12

Certain patient characteristics sometimes affect the likelihood of dying in hospital, but results are highly variable. The Nova Scotia study found that younger patients were more likely to the in hospital;5 this was corroborated in a number of other studies,6,9-11,13 but was not the case in some.7,10,14 The Nova Scotia study also found that females were more likely to die out of hospital,5 and other studies tended to agree.7,10,12,13 Australian and United Kingdom studies found that prostate, breast and haematological cancer patients were more likely to the in hospital than those with other types of cancers.10,15

Both in Canada and elsewhere, most, if not all, the information on place of death has come from short-term and localized studies. In order to help more patients fulfil their wish of not dying in hospital, more information is needed on trends over a longer period of time covering larger populations. Our objective is to use Canadian national databases to determine what proportion of cancer deaths occurred in hospitals, and of those not occurring in hospital, whether they occurred at home. While Canadian national databases are valuable resources for comprehensive nationwide data, they do have limitations, and thus, a secondary objective will be to examine the extent to which such information can reliably be derived from these databases.


The two sources of data were the Hospital Morbidity Databases (HMD) and the Vital Statistics Database which includes the death certificates (DC). Hospital separations (HS) with cancer as primary cause for hospitalization and with discharge as 'dead' were selected from HMD. …

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