193002 Sociodemographic, clinical and economic factors associated with the place of death of elderly mexicans

Monday, November 9, 2009

Marylou Cardenas-Turanzas, MD, Dr PH , Department of Critical Care Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, TX
Isabel Torres-Vigil, Dr PH , Department of Minority Health Center for Health Disparities Res, The University of Texas M. D. Anderson Cancer Center, Houston, TX
Horacio Tovalin-Ahumada, MD, DrPH , Division de Estudios Superiores FES Zaragoza, Universidad Nacional Autonoma de Mexico, Mexico DF, Mexico
Susan Gaeta , Department of Critical Care, The University of Texas M. D. Anderson Cancer Center, Houston, TX, Afghanistan
Joseph L. Nates, MD , Department pf Critical Care, The University of Texas M. D. Anderson Cancer Center, Houston, TX
Purpose: With the aim to inform policy decisions on palliative care and end-of-life in Mexico, we described the factors associated with the place of death in a group of elderly Mexicans.

Methods: Retrospective study using the MHAS survey. Cases included were older adults and their spouses/partners who participated in the MHAS 2001 and 2003 baseline and follow-up interviews. Cases with missing information were excluded. The main study outcome was place of death. The associations between sociodemographic, clinical and economic factors and place of death were examined by using logistic regression analysis.

Results: A total of 473 cases met the inclusion criteria and (250, 52.9%) died at home. The factors significantly associated with death in a hospital were living in a city of 100,000 or more inhabitants [OR 2.30 95% CI 1.16, 4.54], the death occurred away from the city of usual residency [OR 4.77 95% CI 2.24, 10.15], the cause of death was stroke [OR 4.26, 95% CI 1.27, 14.26] and the deceased had not had to paid for hospital stays during the last year of life [OR 3.75 95% CI 1.74, 8.08]. Significant protective factors against dying in hospitals were old age, [OR 0.97 95% CI 0.95, 0.99] and cancer as the cause of the death [OR 0.46 95% CI 0.22, 0.95].

Conclusions:Health planners should consider determinants of place of death when allocating hospital or home-based palliative care units.

Learning Objectives:
To identify determinants of hospital and home death in developing countries To learn the most frequent symptoms and diseases diagnosed during the previous year of death

Keywords: End-of-Life Care, Service Delivery

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am an MD with a DR PH degree and as the Sr. Statistical Analyst of the Department of Critical Care I had participated in the design of this project as well as completed the analyses of the data presented.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.