Geographical variations of place of death among Italian communities suggest an inappropriate hospital use in the terminal phase of cancer disease

This study aimed to assess geographic variations of place of death among It alian communities, to investigate the determinants of home death, and to ex amine trends in the proportion of home deaths over a period of 8 y. A cross -sectional analysis was performed on 13 provinces from two Italian regions (Liguria and Toscana), and the geographic variations and determinants of ho me death were studied for the 17 597 residents, who died of cancer in 1991. Trends for both the regions of the proportion of home deaths were examined for the period 1987 and 1995. A remarkable heterogeneity in the observed p roportion of home deaths among the 13 provinces was observed, ranging betwe en 31.4 and 40.4% in Liguria and between 37.7 and 73.3% in Toscana. The est imated proportion of home deaths after adjustment for age, gender, marital status, education, place of birth, characteristics of the living an:a, and cancer site remained substantially the same. The proportion of home deaths significantly increased with increasing age, and years of education. It was higher among females, married and widowed patients, native patients, and f or residents in a semiurban or rural areas. A significant decrease in the p ercentage of patients who died at home between 1987 and 1995 in both region s was observed. The wide geographical and social differences observed betwe en and within the communities for the frequency of home deaths are not expl ained by the distribution of known determinants, and possibly suggest patte rns of inappropriate hospital admissions in the terminal phase of disease.