Determinants of the place of death in the Brussels metropolitan region.

The place where people die is not only considered an indicator of quality of death, but also has implications for health care costs and the organization of end-of-life care. Advancing urbanization, combined with social fragmentation, poor social conditions, and concentration of inpatient care in large cities make it relevant to study the place of death in a metropolitan context. The objective of this article is to examine determinants of place of death (home, care home, hospital) in a Belgian metropolitan region (Brussels) for patients suffering from chronic diseases eligible for palliative care. Using death certificate data, we describe place of death and associated factors for all deaths after chronic diseases in 2003 in Brussels (n=3672). Of all chronically ill patients, 15.1% died at home, 63.0% in hospital, and 21.6% in a care home. Of those residing in care homes, 23.8% died in hospital. Noncancer patients and residents of districts with higher socioeconomic status had a higher chance of dying at home or in a care home if they resided in one. Home death was also more likely for patients not living alone. Care home death was more likely with increasing age. Compared with other parts of Belgium and other big cities worldwide, few patients eligible for palliative care in Brussels died at home. Both the overall low proportion of people dying in familiar surroundings and the inequality between different districts in Brussels imply that a health policy aiming at facilitating dying in the place of choice might also need to develop specific approaches for metropolitan cities.