"A cross national study of death via death certificates" suivi de
"Medical End-of-Life decisions in six European countries"
A cross-national study of the place of death via death
certificates: a SWOT-analysis" par Johan Bilsen (Vrije Universiteit
Brussel)
et Medical End-of-Life Decisions in six European Countries par
Joachim Cohen (Vrije Universiteit Brussel)
Discutant : Alain Monnier (INED).
BACKGROUND
Studying the place of death and influencing factors is highly relevant for public health policy. Despite some well-known limitations, death certificate data provide a unique opportunity in this context, because they make it possible to use large numbers, and therefore provide more statistical power. This study describes the first phase of the DW-DCS study, in which we examined the possibilities and difficulties in obtaining national/regional death certificate data to study the place of death.
METHODS
We aimed to collect a database, containing all deaths of one year in the countries participating to the study: BE, DK, IT, NL, NO, SE, UK. Next to the place of death we aimed to include a minimal number of clinical, socio-demographic, residential and health care system factors. All partners of the study negotiated a minimal dataset with their administration of mortality statistics.
RESULTS
Sufficient information about the place of death was available on all databases, except in IT (‘home’ versus ‘other’), DK (‘hospital’, ‘institution’ and ‘others’) and SE (certified but not recorded, although ‘hospital’ vs. ‘other’ could be deduced from the postcodes of the parish of death). In BE and IT most desired clinical and socio-demographic information was available via the countries’ death certificates. In the other countries linkages with other population databases needed to be made. The desired residential and health care system factors were available by linking existing statistics to the municipality of residence of the deceased.
DISCUSSION
Death certificate data provide a unique opportunity to study and monitor the place of death and the associated factors in an international context. However several difficulties arose (e.g. variation between countries in the information on death certificates, and in official rules and procedures to get the data). We suggest modifications of certain aspects of the death certificate registration and the rules of data-protection in order to make an international monitoring of the place of death more feasible.