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

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

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.

Aids, End-of-life care, HIV, Mortality, Place of death
1471-2334
1-8
Harding, Richard
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Marchetti, Stefano
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Onwuteaka-Philipsen, Bregje D.
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Wilson, Donna M.
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Ruiz-Ramos, Miguel
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Cardenas-Turanzas, Maria
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Rhee, Yong Joo
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Morin, Lucas
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Hunt, Katherine
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Teno, Joan
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Hakanson, Cecilia
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Houttekier, Dirk
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Deliens, Luc
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Cohen, Joachim
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Harding, Richard
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Marchetti, Stefano
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Onwuteaka-Philipsen, Bregje D.
257f7008-46cb-4622-9c98-77131835d612
Wilson, Donna M.
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Ruiz-Ramos, Miguel
e4d2f743-e56d-4a9c-9854-7c7fd9b6f2bc
Cardenas-Turanzas, Maria
f06b98c7-7625-46dc-800d-789021b5e674
Rhee, Yong Joo
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Morin, Lucas
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Hunt, Katherine
5eab8123-1157-4d4e-a7d9-5fd817218c6e
Teno, Joan
86699157-5338-46e1-9396-d20775c953bd
Hakanson, Cecilia
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Houttekier, Dirk
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Deliens, Luc
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Cohen, Joachim
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Harding, Richard, Marchetti, Stefano, Onwuteaka-Philipsen, Bregje D., Wilson, Donna M., Ruiz-Ramos, Miguel, Cardenas-Turanzas, Maria, Rhee, Yong Joo, Morin, Lucas, Hunt, Katherine, Teno, Joan, Hakanson, Cecilia, Houttekier, Dirk, Deliens, Luc and Cohen, Joachim (2018) Place of death for people with HIV: A population-level comparison of eleven countries across three continents using death certificate data. BMC Infectious Diseases, 18 (1), 1-8, [55]. (doi:10.1186/s12879-018-2951-x).

Record type: Article

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.

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Accepted/In Press date: 5 January 2018
e-pub ahead of print date: 25 January 2018
Keywords: Aids, End-of-life care, HIV, Mortality, Place of death

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Local EPrints ID: 417982
URI: http://eprints.soton.ac.uk/id/eprint/417982
ISSN: 1471-2334
PURE UUID: 8cd1e92d-81dd-4256-8b6f-cc76815ef165
ORCID for Katherine Hunt: ORCID iD orcid.org/0000-0002-6173-7319

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Date deposited: 20 Feb 2018 17:30
Last modified: 07 Oct 2020 01:58

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