Immigration status and other explanatory factors associated with place of death - a population-based register study

Place of death is a quality measure in palliative care. How place of death is influenced by immigration status, cause of death and sociodemographic factors at population level is sparsely elucidated. The aim was to analyse associations between place of death and these factors, which may be of interest in the healthcare system's efforts to offer equal access to the preferred place of death.

In a national register-based study, using health and sociodemographic registers we included adult native and immigrant residents, who died from natural causes in Denmark during 2012 to 2020. In total, 453,219 decedents were included, of which 435,164 (96.0%) were native, 7205 (1.6%) were non-Western immigrants and 10,850 (2.4%) were Western immigrants. The main outcome was the place of death in hospital, home or in other places.

Non-Western immigrants were less likely to die at home versus hospital compared with natives. Adjusting for sociodemographic variables reduced the relative risk ratio of dying at home versus hospital for non-Western immigrants from 0.59 (95% confidence interval (CI) 0.56-0.62) to 0.81 (95% CI 0.77-0.85). Western immigrants resembled the native population. Sex, age, income, education, marital status, cohabitation, geographic region and cause of death were also associated with place of death.

Differences between non-Western immigrants and natives is partly explained by socio-demographic factors which might be accounted for in the provision of end-of-life care. However, a considerable part of the difference in place of death is explained by other factors, which are important to explore to accommodate wishes for place of death equally to all citizens.