Original ArticleGeographical distribution and evolution of deaths in hospitals in Spain, 1996–2015Distribución geográfica y evolución de las muertes en hospitales en España, 1996–2015☆
Section snippets
Background
Where a patient dies depends on numerous factors of a clinical, healthcare, social and cultural nature. The location has important repercussions on the individual level, because the circumstances of an individual's death become part of their relatives’ history and that of their close friends and affects the organization of healthcare facilities for their care. It has been reported that most patients prefer to die at home, although in many cases death occurs in a hospital.1, 2, 3, 4, 5, 6
In
Materials and Methods
The study used an ecological design. We obtained information on deaths for all of Spain between 1996 and 2015, using detailed data or microdata from the Natural Population Movement available online at INE15 and those that occurred in hospitals during the same period through the Specialized Care Information System (SIAE), a survey that all public and private hospitals are required to participate in, whose detailed data are available online from the Ministry of Health, Social Services and
Results
During the 20-year study period, there were 7.5 million deaths in Spain, 4 million of which occurred in hospital centers. Table 1 and Fig. 1 show the change in HMR at the national level, with an increase from 49.2% in 1996 to 55.9% in 2007 (runs test: P = 0.006). In contrast, the HMR remained fairly stable in the following years, up to 55.9% in 2015 (runs test: P = 0.70).
For 2013–2015, 82.6% of the hospital deaths occurred in acute care centers, and 17.4% occurred in other hospital modalities
Discussion
Our results show that the HMR in Spain increased from 49% in 1996 to 56% in 2007 and then remained stable to 2015. The variation in HMR among the provinces was from 40% to 70%, with a higher HMR in less rural provinces and those with a greater provisioning of hospital beds.
The place of death is recorded in the statistical bulletins of death, although it is not included among the data that INE displays on its website for access by researchers. In answer to our query, the INE provided this data
Conflict of Interest
The authors declare that they have no conflict of interest.
Acknowledgments
The authors would like to thank the Subdirectorate General of Healthcare Information and Assessment of the Ministry of Health, Social Services and Equality, who provided the SIAE data.
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Please cite this article as: Jiménez-Puente A, Alegría JG. Distribución geográfica y evolución de las muertes en hospitales en España, 1996–2015. Revista Clínica Española. 2018;218:285–292.