{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T02:20:44Z","timestamp":1776478844444,"version":"3.51.2"},"reference-count":35,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2017,12,13]],"date-time":"2017-12-13T00:00:00Z","timestamp":1513123200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100000348","name":"Calouste Gulbenkian Foundation","doi-asserted-by":"publisher","award":["n\/a"],"award-info":[{"award-number":["n\/a"]}],"id":[{"id":"10.13039\/501100000348","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Palliat Med"],"published-print":{"date-parts":[[2018,4]]},"abstract":"<jats:sec><jats:title>Background:<\/jats:title><jats:p> Most people would prefer to die at home as opposed to hospital; therefore, understanding mortality patterns by place of death is essential for health resources allocation. <\/jats:p><\/jats:sec><jats:sec><jats:title>Aim:<\/jats:title><jats:p> We examined trends and risk factors for hospital death in conditions needing palliative care in a country without integrated palliative care. <\/jats:p><\/jats:sec><jats:sec><jats:title>Design:<\/jats:title><jats:p> This is a death certificate study. We examined factors associated with hospital death using logistic regression. <\/jats:p><\/jats:sec><jats:sec><jats:title>Setting\/participants:<\/jats:title><jats:p> All adults (1,045,381) who died between 2003 and 2012 in Portugal were included. We identified conditions needing palliative care from main causes of death: cancer, heart\/cerebrovascular, renal, liver, respiratory and neurodegenerative diseases, dementia\/Alzheimer\u2019s\/senility and HIV\/AIDS. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results:<\/jats:title><jats:p> Conditions needing palliative care were responsible for 70.7% deaths ( N = 738,566, median age 80); heart and cerebrovascular diseases (43.9%) and cancer (32.2%) accounted for most. There was a trend towards hospital death (standardised percentage: 56.3% in 2003, 66.7% in 2012; adjusted odds ratio: 1.04, 95% confidence interval: 1.04\u20131.04). Hospital death risk was higher for those aged 18\u201339 years (3.46, 3.25\u20133.69 vs aged 90+), decreasing linearly with age; lower in dementia\/Alzheimer\u2019s\/senility versus cancer (0.13, 0.13\u20130.13); and higher for the married and in HIV\/AIDS (3.31, 3.00\u20133.66). Effects of gender, working status, weekday and month of death, hospital beds availability, urbanisation level and deprivation were small. <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion:<\/jats:title><jats:p> The upward hospital death trend and fact that being married are risk factors for hospital death suggest that a reliance on hospitals may coexist with a tradition of extended family support. The sustainability of this model needs to be assessed within the global transition pattern in where people die. <\/jats:p><\/jats:sec>","DOI":"10.1177\/0269216317743961","type":"journal-article","created":{"date-parts":[[2017,12,13]],"date-time":"2017-12-13T14:51:46Z","timestamp":1513176706000},"page":"891-901","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":49,"title":["Risk factors for hospital death in conditions needing palliative care: Nationwide population-based death certificate study"],"prefix":"10.1177","volume":"32","author":[{"given":"Barbara","family":"Gomes","sequence":"first","affiliation":[{"name":"Faculty of Medicine, University of Coimbra, Coimbra, Portugal"},{"name":"Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King\u2019s College London, London, UK"}]},{"given":"Maria Jo\u00e3o","family":"Pinheiro","sequence":"additional","affiliation":[{"name":"National School of Public Health, Universidade Nova de Lisboa, Lisbon, Portugal"}]},{"given":"S\u00edlvia","family":"Lopes","sequence":"additional","affiliation":[{"name":"National School of Public Health, Universidade Nova de Lisboa, Lisbon, Portugal"},{"name":"Public Health Research Centre, National School of Public Health, Universidade Nova de Lisboa, Lisbon, Portugal"}]},{"given":"Maja","family":"de Brito","sequence":"additional","affiliation":[{"name":"Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King\u2019s College London, London, UK"}]},{"given":"Vera P","family":"Sarmento","sequence":"additional","affiliation":[{"name":"Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King\u2019s College London, London, UK"},{"name":"Hospital Esp\u00edrito Santo de \u00c9vora, \u00c9vora, Portugal"}]},{"given":"Pedro","family":"Lopes Ferreira","sequence":"additional","affiliation":[{"name":"Centre for Studies and Health Research of the University of Coimbra, Coimbra, Portugal"},{"name":"Faculty of Economics, University of Coimbra, Coimbra, Portugal"}]},{"given":"Henrique","family":"Barros","sequence":"additional","affiliation":[{"name":"EPIUnit, Institute of Public Health of the University of Porto, Oporto, Portugal"}]}],"member":"179","published-online":{"date-parts":[[2017,12,13]]},"reference":[{"key":"bibr1-0269216317743961","doi-asserted-by":"publisher","DOI":"10.1038\/495449c"},{"key":"bibr2-0269216317743961","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1404427"},{"key":"bibr3-0269216317743961","doi-asserted-by":"publisher","DOI":"10.1186\/1472-684X-12-7"},{"key":"bibr4-0269216317743961","doi-asserted-by":"publisher","DOI":"10.1007\/s00038-012-0394-5"},{"key":"bibr5-0269216317743961","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38740.614954.55"},{"key":"bibr6-0269216317743961","doi-asserted-by":"publisher","DOI":"10.1136\/jech-2014-205365"},{"issue":"6","key":"bibr7-0269216317743961","first-page":"CD007760","volume":"6","author":"Gomes B","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"bibr8-0269216317743961","unstructured":"World Health Organization (WHO). Strengthening of palliative care as a component of comprehensive care throughout the life course. Report no. 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