Comprehensiveness and correspondence of place of death classifications: an international comparative analysis

Abstract

Background/aims: Respecting preferences for place of death (PoD) is important. The first step is to classify PoD in a way that captures the full spectrum of places that are meaningful for individuals. We aimed to describe the comprehensiveness and correspondence of PoD classifications globally. Methods: We sought information on PoD classifications from vital registries of 47 countries varied in UN Regions and Quality of Death Index. We describe the structure of PoD classifications (2020-21), cross-linking the categories and wording used in the countries. We focus attention on the entity “home” as it is the most common preference for PoD. Results: Of 22 responding countries (16 EU), 21 use a single PoD classification structure and only Portugal uses a hierarchical classification (in 3 levels, with sub-categories within health institutions and specific services within hospitals, such as ICU and emergency department). Categories range 3 to 21, the most common (present in all countries) were: home (however the wording varies), hospital, health care or medical institution/health establishment (however differences limit comparability), and other/elsewhere. Home is captured in 1-3 categories per country, with wide-ranged wording: home, courtyard, domicile, home/ non-institution, home of family members, home of friend, private house, private home, private residence and residential house. Cyprus and Luxembourg use the most comprehensive classifications (21 and 18 categories, respectively). Final findings from all countries will be presented at the conference. Conclusions: There is scope to improve the comprehensiveness of PoD classifications and category correspondence. Although all countries capture “home,” there are critical variations in wording. An exhaustive international PoD classification will allow better cross-country data and studies mapping preferred and actual PoD, critical to help provide choice on where people die across world regions.