A study of home deaths in Japan from 1951 to 2002

BACKGROUND: Several surveys in Japan have indicated that most terminally ill Japanese patients would prefer to die at home or in a homelike setting. However, there is a great disparity between this stated preference and the reality, since most Japanese die in hospital. We report here national changes in home deaths in Japan over the last 5 decades. Using prefecture data, we also examined the factors in the medical service associated with home death in Japan. METHODS: Published data on place of death was obtained from the vital statistics compiled by the Ministry of Health, Labor and Welfare of Japan. We analyzed trends of home deaths from 1951 to 2002, and describe the changes in the proportion of home deaths by region, sex, age, and cause of death. Joinpoint regression analysis was used for trend analysis. Logistic regression analysis was performed to identify secular trends in home deaths, and the impact of age, sex, year of deaths and cause of deaths on home death. We also examined the association between home death and medical service factors by multiple regression analysis, using home death rate by prefectures in 2002 as a dependent variable. RESULTS: A significant decrease in the percentage of patients dying at home was observed in the results of joinpoint regression analysis. Older patients and males were more likely to die at home. Patients who died from cancer were less likely to die at home. The results of multiple regression analysis indicated that home death was related to the number of beds in hospital, ratio of daily occupied beds in general hospital, the number of families in which the elderly were living alone, and dwelling rooms. CONCLUSION: The pattern of the place of death has not only been determined by social and demographic characteristics of the decedent, but also associated with the medical service in the community.