Original Article
Geographical distribution and evolution of deaths in hospitals in Spain, 1996–2015Distribución geográfica y evolución de las muertes en hospitales en España, 1996–2015

https://doi.org/10.1016/j.rceng.2018.03.020Get rights and content

Abstract

Background and objective

The location where death occurs varies widely among societies. The aim of this study was to describe the evolution in the hospital mortality rate (HMR) in Spain over the course of 20 years and its distribution by province during a more recent period and to explore its relationship with potential explanatory variables.

Methods

This was an ecological study. The population mortality rates were obtained from the Natural Population Movement (Movimiento Natural de la Población), and the hospital mortality rates were obtained from the Specialized Care Information System (Sistema de Información en Atención Especializada), which includes information from all hospitals in Spain. We calculated the mortality rates for patients who were not surveyed and the HMR at the national level between 1996 and 2015 and for provinces between 2013 and 2015. The relationship between the provincial distribution of HMR and various demographic, socioeconomic and healthcare variables were analyzed through simple and multiple linear regressions.

Results

The HMR in Spain increased from 49% in 1996 to 56% in 2007, having remained stable from 1996 to 2015. The variation among provinces was 40–70%. The multivariate analysis showed a higher HMR in the less rural provinces and in those with a larger availability of hospital beds.

Conclusions

There is considerable provincial heterogeneity in Spain in terms of the probability of dying in hospital or at home. This result could be partly explained by demographics (percentage of rural population) and the healthcare structure (number of hospital beds per population).

Resumen

Antecedentes y objetivo

El lugar en que se produce la muerte varía ampliamente en las distintas sociedades. El objetivo del estudio fue describir la evolución del porcentaje de muertes en hospitales (PMH) en España a lo largo de 20 años, así como su distribución por provincias en un periodo más reciente y explorar su relación con posibles variables explicativas.

Métodos

El estudio fue ecológico. Las muertes poblacionales se obtuvieron del Movimiento Natural de la Población, y las muertes en hospitales, del Sistema de Información en Atención Especializada, que incluye información de todos los hospitales del país. Se estimaron las muertes de pacientes no censados y se calculó el PMH a nivel nacional entre 1996 y 2015 y por provincias entre 2013 y 2015. La relación entre la distribución provincial del PMH y diversas variables de tipo demográfico, socioeconómico y asistencial se analizó mediante regresión lineal simple y múltiple.

Resultados

El PMH ascendió en España desde el 49% en 1996 hasta el 56% en 2007, habiendo permanecido estable desde entonces hasta 2015. Su variación entre provincias fue del 40 al 70%. El análisis multivariante mostró un PMH superior en las provincias menos rurales y en aquellas con mayor dotación de camas hospitalarias.

Conclusiones

En España existe una gran heterogeneidad provincial en cuanto a la probabilidad de morir en un hospital o en el domicilio. Esto se justifica en parte por razones sociodemográficas (porcentaje de población rural) y de la estructura sanitaria (número de camas hospitalarias por población).

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.

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