Mortality in general practice: problems concerning deaths in institutions

Following the provision of all general practitioners in Grampian with data on their practice death rates, the experience of death rates at institutions in the region was examined. Nursing homes are more likely to be situated in less deprived areas and their age-specific death rates are generally higher than those experienced by residents from non-institutional settings. For residents in non-institutional settings in Grampian, higher death rates generally parallel increasing deprivation. This expected trend is reversed when describing the mortality experience of nursing home residents. One reason for this is the movement of elderly people to the locations of nursing homes in less deprived areas. Methodological issues are discussed and proposals are made to improve the analysis of mortality in this article.