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01.12.2018 | Research article | Ausgabe 1/2018 Open Access

BMC Infectious Diseases 1/2018

Place of death for people with HIV: a population-level comparison of eleven countries across three continents using death certificate data

Zeitschrift:
BMC Infectious Diseases > Ausgabe 1/2018
Autoren:
Richard Harding, Stefano Marchetti, Bregje D. Onwuteaka-Philipsen, Donna M. Wilson, Miguel Ruiz-Ramos, Maria Cardenas-Turanzas, YongJoo Rhee, Lucas Morin, Katherine Hunt, Joan Teno, Cecilia Hakanson, Dirk Houttekier, Luc Deliens, Joachim Cohen
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s12879-018-2951-x) contains supplementary material, which is available to authorized users.

Abstract

Background

With over 1 million HIV-related deaths annually, quality end-of-life care remains a priority. Given strong public preference for home death, place of death is an important consideration for quality care. This 11 country study aimed to i) describe the number, proportion of all deaths, and demographics of HIV-related deaths; ii) identify place of death; iii) compare place of death to cancer patients iv), determine patient/health system factors associated with place of HIV-related death.

Methods

In this retrospective analysis of death certification, data were extracted for the full population (ICD-10 codes B20-B24) for 1-year period: deceased’s demographic characteristics, place of death, healthcare supply.

Results

i) 19,739 deaths were attributed to HIV. The highest proportion (per 1000 deaths) was for Mexico (9.8‰), and the lowest Sweden (0.2‰). The majority of deaths were among men (75%), and those aged <50 (69.1%). ii) Hospital was most common place of death in all countries: from 56.6% in the Netherlands to 90.9% in South Korea. The least common places were hospice facility (3.3%–5.7%), nursing home (0%–17.6%) and home (5.9%–26.3%).iii) Age-standardised relative risks found those with HIV less likely to die at home and more likely to die in hospital compared with cancer patients, and in most countries more likely to die in a nursing home. iv) Multivariate analysis found that men were more likely to die at home in UK, Canada, USA and Mexico; a greater number of hospital beds reduced the likelihood of dying at home in Italy and Mexico; a higher number of GPs was associated with home death in Italy and Mexico.

Conclusions

With increasing comorbidity among people ageing with HIV, it is essential that end-of-life preferences are established and met. Differences in place of death according to country and diagnosis demonstrate the importance of ensuring a “good death” for people with HIV, alongside efforts to optimise treatment.
Zusatzmaterial
Additional file 1: Table S1. Supplementary Material for Place of death for people with HIV: a population-level comparison of eleven countries across three continents using death certificate data. About different data sources and the levels of linkage of data. Table S2. Descriptive data on HIV prevalence and ART coverage for each country, drawn from UNAIDS Global Report 2008. Description of HIV prevalence and ART coverage for each participating country. (DOCX 28 kb)
12879_2018_2951_MOESM1_ESM.docx
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