Place of death of children with complex chronic conditions: cross-national study of 11 countries.

Cross-national understanding of place of death is crucial for health service systems for their provision of efficient and equal access to paediatric palliative care. The objectives of this population-level study were to examine where children with complex chronic conditions (CCC) die and to investigate associations between places of death and sex, cause of death and country. The study used death certificate data of all deceased 1- to 17-year-old children (n = 40,624) who died in 2008, in 11 European and non-European countries. Multivariable logistic regression was performed to determine associations between place of death and other factors. Between 24.4 and 75.3% of all children 1-17 years in the countries died of CCC. Of these, between 6.7 and 42.4% died at home. In Belgium and the USA, all deaths caused by CCC other than malignancies were less likely to occur at home, whereas in Mexico and South Korea, deaths caused by neuromuscular diseases were more likely to occur at home than malignancies. In Mexico (OR = 0.91, 95% CI: 0.83-1.00) and Sweden (OR = 0.35, 95% CI: 0.15-0.83), girls had a significantly lower chance of dying at home than boys. CONCLUSION: This study shows large cross-national variations in place of death. These variations may relate to health system-related infrastructures and policies, and differences in cultural values related to place of death, although this needs further investigation. The patterns found in this study can inform the development of paediatric palliative care programs internationally. What is known: • There is a scarcity of population-level studies investigating where children with CCC die in different countries. • Cross-national understanding of place of death provides information to health care systems for providing efficient and equal access to paediatric palliative care. What is new : • There are large cross-national variations in the place of death of children with CCC, with few deathsoccuring at home in some countries whereas hospital deaths are generally most common. • In general, deaths caused by neuromuscular diseases and malignancies occur at home more often thanother CCC.

Rising trends in oral cancer mortality in Spain, 1975-94.

BACKGROUND: Epidemiological studies have shown that the worldwide incidence and mortality rates for oral cancer have increased considerably over the last decade. This study investigates the Spanish trend in mortality of oral cancer from 1975-94. METHODS: Age-standardized, truncated, cumulative, age-specific and potential years of life lost (PYLL) rates were calculated by gender. Poisson regression models allowed the measurement of age and period effects. RESULTS: Age-standardized and cumulative mortality rates increased in males, while truncated and PYLL rates doubled. Changes were less marked in females. There were annual increases in oral cancer mortality from 1975-94, of 25% and 9% in males and females, respectively. In males there was an interaction between age and period. There was also an increase in age-specific mortality rates in males. CONCLUSIONS: Mortality from oral cancer rose substantially in males, with concomitant changes in the age-distribution pattern of mortality. Increases were less marked in females, with some minor modifications to the age-distribution pattern of mortality.