Did we change for the better? Recoding place of death in Czechia, Estonia, Finland, Luxemburg and Portugal (2012-2021)

Abstract

Background/aims: Introducing changes in how we classify place of death (PoD) in death registrations is important if this improves the quality of the data and their usefulness. We aimed to examine changes in coding PoD globally, comparing pre- and post-change data. Methods: We sought national PoD data from vital registries of 47 countries varied in UN Regions and Quality of Death Index. We asked whether PoD coding changed from 2012 to 2021 and if so how. We describe changes and compare pre-post change PoD data. Results: Of 22 responding countries, PoD was recoded in Czechia (in 2013), Estonia (2019), Finland (2016), Luxemburg (annually) and Portugal (2014). Most notable changes were: Czechia: sub-categorisation of “medical institution” as “inpatient” vs. “other” and introduction of “not identified” PoD; Estonia: added “nursing home” and “workplace”; Finland: added “social care unit”; Portugal: sub-categorisation of “health institution” into “primary care centers” and “hospitals” (and within: “inpatient ward”, “intensive care unit”, “emergency department” or “other”). Luxemburg generated every year 10-18 sub-categories that emerged from free-text of the “other” category, the most frequent being “home of a family member” (0.2% in 2021). Data on 2.8 million deceased across the 5 countries (2012-2021) showed changes had minimal impact on existing categories (⩽5% change) except in “health care facility” in Estonia (-6%) in favor of “nursing home” (12% in 2021) and in “other” in Finland (-13%) in favor of “social care unit” (23% in 2020). Conclusions: 5 EU countries refined PoD data and unveiled key trends. This shows it is possible to change PoD coding for the better. Luxembourg’s inductive coding of the category “other” represents added work but also value. The findings are informing the development of a pioneering international classification of dying places.