Place of Death

  • Charts and Tables

    Charts and Tables

    Figure 5.3

    Percentage of cancer deaths occurring in hospital, private home or other, by province — 2011 death year

    “Other” includes other specified locations, other health care facilities, and unknown locations.
    Hospices can be classified as “Other” or “Hospital” depending on province.
    The definition of hospital varied across provinces. QC: “Hospital” included residential and long-term care centres. MB: Designated palliative care units were included in “Hospital.” In other provinces this type of bed might have been considered part of long-term care (“Other”). As a result, percentages of hospital deaths for QC and MB may appear higher relative to other provinces but do not necessarily indicate any actual differences in delivery of services.
    The way palliative care beds are designated in hospitals varies across provinces. The resulting variation in reporting deaths that occurred in hospital is unknown.
    Coding on death certificates varies by province. SK and PE: A very small proportion of deaths are recorded at home, suggesting that most in-home deaths may be recorded in “Other.”
    Data source: Statistics Canada, Vital Statistics Death Database.

    Data Table

    ProvinceLocation of deathNumber of deathsPercent (%)
    BCHospital4,55549.8
    BCPrivate Home1,43515.7
    BCOther3,15534.5
    ABHospital3,62063.6
    ABPrivate Home56510.0
    ABOther1,50526.4
    SKHospital1,58069.5
    SKOther69030.5
    MBHospital2,39089.4
    MBPrivate Home27510.2
    MBOther100.4
    ONHospital17,27564.2
    ONPrivate Home5,13519.1
    ONOther4,50016.7
    QCHospital15,28577.8
    QCPrivate Home9304.7
    QCOther3,43017.5
    NBHospital1,36575.6
    NBPrivate Home26514.7
    NBOther1759.7
    NSHospital1,82070.0
    NSPrivate Home56521.7
    NSOther2158.2
    PEHospital20062.6
    PEPrivate Home258.1
    PEOther9529.3
    NLHospital1,03578.1
    NLPrivate Home16512.6
    NLOther1209.3

    “Other” includes other specified locations, other health care facilities, and unknown locations.
    Hospices can be classified as “Other” or “Hospital” depending on province.
    The definition of hospital varied across provinces. QC: “Hospital” included residential and long-term care centres. MB: Designated palliative care units were included in “Hospital.” In other provinces this type of bed might have been considered part of long-term care (“Other”). As a result, percentages of hospital deaths for QC and MB may appear higher relative to other provinces but do not necessarily indicate any actual differences in delivery of services.
    The way palliative care beds are designated in hospitals varies across provinces. The resulting variation in reporting deaths that occurred in hospital is unknown.
    Coding on death certificates varies by province. SK and PE: A very small proportion of deaths are recorded at home, suggesting that most in-home deaths may be recorded in “Other.”
    Data source: Statistics Canada, Vital Statistics Death Database.

    Figure 5.4

    Percentage of cancer deaths occurring in hospital, private home or other, Canada — from 2007 to 2011 death years

    “Other” includes other specified locations, other health care facilities, and unknown locations.
    Hospices can be classified as “Other” or “Hospital” depending on province.
    The definition of hospital varied across provinces. QC: “Hospital” included residential and long-term care centres. MB: Designated palliative care units were included in “Hospital.” In other provinces this type of bed might have been considered part of long-term care (“Other”). As a result, percentages of hospital deaths for QC and MB may appear higher relative to other provinces but do not necessarily indicate any actual differences in delivery of services.
    The way palliative care beds are designated in hospitals varies across provinces. The resulting variation in reporting deaths that occurred in hospital is unknown.
    Coding on death certificates varies by province. SK and PE: A very small proportion of deaths are recorded at home, suggesting that most in-home deaths may be recorded in “Other.”
    Data source: Statistics Canada, Vital Statistics Death Database.

    Data Table

    Location of deathYear Number of deathsPercent (%)
    Hospital200749,69171.5
    Hospital200850,43871.6
    Hospital200950,19870.7
    Hospital201049,65069.2
    Hospital201149,12567.9
    Private home20079,04413.0
    Private home 20088,28411.8
    Private home20099,52813.4
    Private home20109,89513.8
    Private home20119,36012.9
    Other200710,78315.5
    Other200811,71816.6
    Other200911,29715.9
    Other201012,25517.1
    Other201113,89519.2

    “Other” includes other specified locations, other health care facilities, and unknown locations.
    Hospices can be classified as “Other” or “Hospital” depending on province.
    The definition of hospital varied across provinces. QC: “Hospital” included residential and long-term care centres. MB: Designated palliative care units were included in “Hospital.” In other provinces this type of bed might have been considered part of long-term care (“Other”). As a result, percentages of hospital deaths for QC and MB may appear higher relative to other provinces but do not necessarily indicate any actual differences in delivery of services.
    The way palliative care beds are designated in hospitals varies across provinces. The resulting variation in reporting deaths that occurred in hospital is unknown.
    Coding on death certificates varies by province. SK and PE: A very small proportion of deaths are recorded at home, suggesting that most in-home deaths may be recorded in “Other.”
    Data source: Statistics Canada, Vital Statistics Death Database.

  • About this indicator

    About this indicator

    Indicator definition

    The percentage of cancer patients who died in hospital versus non-hospital locations (i.e., private home, other) in 2011. Results are reported by province and year.

    Measured since

    The 2010 Cancer System Performance Report.

    Update frequency

    Every two years

    Why measure this?

    Studies suggest that given the choice, most cancer patients in Canada prefer to die at home or a home-like setting, such as a hospice, if they are well supported and in the presence of loved ones.1,2 Hospitals, however, remain the most common—though least preferred—place of death, which highlights the disparity between end-of-life practice and patient preference.3 In fact, Canada had the highest proportion of cancer patients who died in hospital among seven developed countries, indicating that end-of-life care may be more hospital-centric in Canada.4

    It is important to note that some hospitalizations near the end of life are necessary and some patients prefer to die in the hospital.2 In addition, the availability of health services and resources may influence place of death; for example, symptom management resources (e.g., home visits by family physicians and nurses, specialized palliative care involvement), emotional support for caregivers or loved ones and/or financial resources needed to support dying at home are not always available or realistically achievable at home.5 Measuring place of death, although a crude measure, addresses one important aspect of end-of-life care and may contribute to better planning and quality of end-of-life care for cancer patients.

    What are the key findings?

    • For cancer patients who died in 2011, between 4.7% (Quebec) and 21.7% (Nova Scotia) died in a private home; between 49.8% (British Columbia) and 89.4% (Manitoba) died in hospital (Figure 5.3). Patients who died in hospital may still have received palliative care. It is important to note that provincial variations exist in how location of death is categorized on death certificates and how different settings are classified (e.g., designation of hospital-based hospices or palliative care units). Manitoba has indicated, for example, that many of the in-hospital deaths recorded in the province’s vital statistics data actually occurred in hospital-based hospices or palliative care units, not in acute-care hospital beds.
    • The percentage of cancer patients who died in a private home has remained relatively constant, ranging from 13.0% in 2007 to 12.9% in 2011 (Figure 5.4).

    References

    1. Canadian Cancer Society's Steering Committee. Canadian Cancer Statistics 2010. Toronto (ON): Canadian Cancer Society; 2010. 124 p.
    2. Howell DA, Wang HI, Roman E, Smith AG, Patmore R, Johnson MJ, et al. Preferred and actual place of death in haematological malignancy. BMJ Support Palliat Care. 2015 Jul 8.
    3. Canadian Partnership Against Cancer. The 2014 Cancer System Peformance Report. Toronto (ON): Canadian Partnership Against Cancer; 2014 Mar. 170 p.
    4. Bekelman JE, Halpern SD, Blankart CR, Bynum JP, Cohen J, Fowler R, et al. Comparison of Site of Death, Health Care Utilization, and Hospital Expenditures for Patients Dying With Cancer in 7 Developed Countries. JAMA. 2016 Jan 19;315(3):272-83.
    5. Burge F, Lawson B, Johnston G, Asada Y, McIntyre PF, Flowerdew G. Preferred and Actual Location of Death: What Factors Enable a Preferred Home Death? J Palliat Med. 2015 Dec;18(12):1054-9

     

  • Data specifications

    Data specifications

    Definition: The percentage of cancer patients who died in hospital versus non-hospital locations (i.e., private home, other)

    Numerator:

    1. By province: Number of cancer deaths in hospital, private home and other
    2. Canada: Number of cancer deaths in hospital, private home and other

    Denominator: Number of cancer deaths

    Data source: Canadian Vital Statistics – Death Database (annual file)

    Measurement timeframe: 2007 to 2011

    Provinces/territories with data available: All provinces/territories

    Notes:

    1. The definition of hospital varied across provinces. Hospices can be classified as “Other” or “Hospital” depending on province.
    2. “Other” included other specified locality, other health care facility, private home and unknown localities.
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