RT Journal Article
SR Electronic
T1 Location of death among children with life-threatening conditions: a national population-based observational study using the Canadian Vital Statistics Database (2008–2014)
JF CMAJ Open
JO CMAJ
FD Canadian Medical Association
SP E298
OP E304
DO 10.9778/cmajo.20220070
VO 11
IS 2
A1 Widger, Kimberley
A1 Brennenstuhl, Sarah
A1 Tanuseputro, Peter
A1 Nelson, Katherine E.
A1 Rapoport, Adam
A1 Seow, Hsien
A1 Siden, Harold
A1 Vadeboncoeur, Chris
A1 Gupta, Sumit
YR 2023
UL http://www.cmajopen.ca/content/11/2/E298.abstract
AB Background: Patterns in location of death among children with life-threatening conditions (e.g., cancer, genetic disorders, neurologic conditions) may reveal important inequities in access to hospital and community support services. We aimed to identify demographic, socioeconomic and geographic factors associated with variations in location of death for children across Canada with life-threatening conditions.Methods: We used a retrospective observational cohort design and the Canadian Vital Statistics Database to identify children aged 19 years or younger who died from a life-threatening condition between Jan. 1, 2008, and Dec. 31, 2014. We used multivariable logistic regression to determine predictors of in-hospital death for children aged 1 month to 19 years, and for neonates younger than 1 month.Results: Overall, 13 115 decedents younger than 19 years had life-threatening conditions. Of 5250 children and 7865 neonates, 74.2% and 98.1%, respectively, died in hospital. Among children, we found a higher proportion of hospital deaths in the lowest (v. highest) income quintile (odds ratio [OR] 1.59, 95% confidence interval [CI] 1.28–1.97), and a lower proportion among children living more than 400 km (v. < 50 km) from a pediatric hospital (OR 0.73, 95% CI 0.65–0.86). Compared with Ontario, hospital death was most common in Quebec (OR 1.38, 95% CI 1.14–1.67) and least common in British Columbia (OR 0.43, 95% CI 0.34–0.53). Compared with an oncologic cause of death, all causes except neurologic and metabolic conditions had significantly higher odds of dying in hospital.Interpretation: In addition to demographics, we identified socioeconomic and geographic differences in location of death, suggesting potential inequities in access to high-quality care at the end of life. Health care policies and practices must ensure equitable access to services for children across Canada, particularly at the end of their life.