Older adults with cancer in the city of São Paulo: what factors determine the place of death?

Leite, Adna Kelly Ferreira; Ribeiro, Karina Braga

doi:10.11606/S1518-8787.2018052016410

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Sumário

Original Article • Rev. Saúde Pública 52 • 2018 • https://doi.org/10.11606/S1518-8787.2018052016410 copy

Older adults with cancer in the city of São Paulo: what factors determine the place of death?

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

Investigate factors associated with death at home among older adults who died of cancer in a large city.

METHODS

This is a descriptive study, including all cancer deaths (ICD C00-C97) occurring between 2006 and 2012, among residents of the city of São Paulo, 60 years of age or older. The data source was the Mortality Information System, and the proportion of deaths was calculated according to place of occurrence, gender, age, race/skin color, education, marital status, cancer type, hospital bed availability, and year of death. The chi-squared test was used to examine the associations between the place of death and sociodemographic and clinical variables. Logistic regression was used to identify factors associated with home death. Crude and adjusted odds ratios and the corresponding 95% confidence intervals were estimated.

RESULTS

Most of the deaths occurred in hospitals (88.2%). There was a significant association between the place of death and the following variables: gender, race/skin color, education, age, marital status, cancer type, hospital bed availability, and year of death. In the multivariate analysis, all variables, except the availability of hospital beds, remained as independent predictors of death at home.

CONCLUSIONS

There was a predominance of hospital deaths, with an increase in frequency in the period. Female gender, higher education, married or widowed status, and black race were associated with a decreased risk of death at home, while increasing age, Asian race, and solid neoplasms were associated with higher risk of dying at home.

Aged; Neoplasms, mortality; Hospital Mortality Terminal Care; Palliative Care; Home Nursing; Length of Stay

Variable	n	%
Gender
Male	32,532	51.3
Female	30,811	48.6
Race/Skin color
White	47,989	75.7
Black	3,078	4.8
Asian	1,973	3.1
Mixed	7,053	11.1
Indigenous	20	0.0
Unknown	3,230	5.1
Age group (years)
60–69	21,474	33.9
70–79	23,022	36.3
80–89	15,673	24.7
90 or more	3,174	5.0
Marital status
Single	7,264	11.4
Married	30,044	47.4
Widowed	20,154	31.8
Separated/Divorced	3,965	6.2
Civil partnership	237	0.3
Unknown	1,679	2.6
Education (years of study)
0	5,714	9.0
1–3	15,953	25.1
4–7	14,520	22.9
8–11	9,555	15.0
12 or more	7,791	12.3
Unknown	9,810	15.4
Year of death
2006	8,471	13.4
2007	8,619	13.6
2008	8,813	13.9
2009	8,890	14.0
2010	9,266	14.6
2011	9,550	15.1
2012	9,734	15.4

Type of neoplasm (ICD-10)	Gender (%)

	Male	Female

	n (%)	n (%)
Lung (C34)	5,280 (16.2)	3,365 (10.9)
Prostate (C61)	4,918 (15.1)	-
Colon/Rectum (C18-C20)	3,558 (10.9)	4,046 (13.1)
Stomach (C16)	3,182 (9.8)	2,010 (6.5)
Pancreas (C25)	1,625 (5.0)	2,100 (6.8)
Liver (C22)	1,527 (4.7)	1,225 (3.9)
Esophagus (C15)	1,386 (4.3)	420 (1.4)
Bladder (C67)	1,265 (3.9)	537 (1.7)
Mouth and oropharynx (C00-C06, C09-C10, C14)	1,204 (3.7)	360 (1.2)
Larynx (C32)	1,063 (3.3)	158 (0.5)
Breast (C50)	35 (0.1)	4,697 (15.2)
Ovary (C56)	-	1,244 (4.0)
Central nervous system (C70-C72)	810 (2.5)	963 (3.1)
Non-Hodgkin’s lymphoma (C82-C85)	791 (2.4)	949 (3.1)
Cervix uteri (C53)	-	827 (2.7)
Other neoplasms	5,888 (18.1)	7,910 (25.7)

Total	32,532 (100.0)	30,811 (100.0)

Variable	Place of death		OR (95%CI)	p

	Hospital	Home

	n (%)	n (%)
Gender				< 0.001
Male	28,600 (90.3)	3,070 (9.7)	1.00
Female	27,274 (91.2)	2,629 (8.8)	0.89 (0.85–0.95)
Marital status				< 0.001
Single	6,331 (90.0)	703 (10.0)	1.00
Married	26,999 (91.3)	2,568 (8.7)	0.87 (0.80–0.94)
Widowed	17,559 (90.0)	1,960 (10.0)	1.02 (0.93–1.11)
Separated/Divorced	3,512 (91.8)	315 (8.2)	0.82 (0.71–0.94)
Education (years of study)				< 0.001
None	5,144 (92.6)	413 (7.4)	1.00
1–3	14,242 (92.3)	1,186 (7.7)	0.59 (0.53–0.64)
4–7	12,849 (91.3)	1,212 (8.7)	0.67 (0.62–0.72)
8–11	8,588 (92.1)	728 (7.9)	0.60 (0.55–0.66)
12 or more	6,904 (90.8)	700 (9.2)	0.72 (0.66–0.79)
Age group (years)				< 0.001
60–69	19,409 (92.7)	1,538 (7.3)	1.00
70–79	20,495 (91.4)	1,923 (8.6)	1.18 (1.10–1.27)
80–89	13,428 (88.5)	1,749 (11.5)	1.64 (1.53–1.77)
90 or more	2,542 (83.9)	489 (16.1)	2.43 (2.17–2.71)
Race/Skin color				< 0.001
White	42,071 (90.2)	4,556 (9.8)	1.00
Black/Mixed	9,043 (92.0)	789 (8.0)	0.84 (0.78–0.91)
Asian	1,650 (86.2)	264 (13.8)	1,55 (1.36–1.78)
Indigenous	19 (100.0)	0 (0.0)	NC
Year of death				< 0.001
2006	7,476 (89.7)	859 (10.3)	1.00
2007	7,586 (89.4)	893 (10.5)	1.02 (0.93–1.13)
2008	7,813 (90.1)	855 (9.9)	0.95 (0.86–1.05)
2009	7,968 (10.0)	790 (9.0)	0.86 (0.78–0.95)
2010	8,259 (91.6)	762 (8.4)	0.80 (0.72–0.89)
2011	8,353 (91.3)	793 (8.7)	0.83 (0.75–0.91)
2012	8,419 (91.9)	747 (8.1)	0.77 (0.69–0.86)
Type of neoplasm				< 0.001
Hematologic	4,385 (95.2)	219 (4.8)	1.00
Solid	48,797 (90.5)	5,115 (9.5)	2.09 (1.83–2.41)
Number of hospital beds in the district of residence/1,000 inhabitants				0.004
0	13,826 (90.3)	1,490 (9.7)	1.01 (0.94–1.09)
0.01–1.46	13,388 (91.3)	1,279 (8.7)	0.89 (0.83–0.97)
1.47–3.81	15,285 (91.0)	1,504 (8.9)	0.92 (0.85–0.99)
3.82–38.95	13,375 (90.4)	1,426 (9.6)	1.00

Variable	Category	Crude OR	Adjusted OR	95%CI
Gender
	Male	1.00	1.00	Ref.
	Female	0.89	0.82	0.77–0.88
Marital status
	Single	1.00	1.00	Ref.
	Married	0.87	0.84	0.77–0.92
	Widowed	1.02	0.90	0.83–0.99
	Separated/Divorced	0.82	0.88	0.77–1.02
Education (years of study)
	None	1.00	1.00	Ref.
	1–3	0.59	0.58	0.54–0.63
	4–7	0.67	0.67	0.62–0.73
	8–11	0.60	0.59	0.54–0.65
	≥ 12 years	0.72	0.72	0.65–0.79
Age group (years)
	60–69	1.00	1.00	Ref.
	70–79	1.18	1.18	1.09–1.27
	80–89	1.64	1.63	1.51–1.76
	≥ 90	2.43	2.29	2.03–2.58
Race/Skin color
	White	1.00	1.00	Ref.
	Black/Mixed	0.84	0.84	0.77–0.91
	Asian	1.55	1.51	1.32–1.74
	Indigenous	NC	NC	-
Type of neoplasm
	Hematologic	1.00	1.00	Ref.
	Solid	2.09	2.11	1.83–2.42
Hospital beds/1,000 inhabitants
	0	1.01	1.07	0.98–1.16
	0.01–1.46	0.89	0.93	0.86–1.02
	1.47–3.81	0.92	0.96	0.88–1.04
	3.82–38.95	1.00	1.00	Ref.

Faculdade de Saúde Pública da Universidade de São Paulo Avenida Dr. Arnaldo, 715, 01246-904 São Paulo SP Brazil, Tel./Fax: +55 11 3061-7985 - São Paulo - SP - Brazil
E-mail: revsp@usp.br

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[1] Correspondence: Karina Braga Ribeiro. Departamento de Saúde Coletiva, Faculdade de Ciências Médicas da Santa Casa de São Paulo, Rua Doutor Cesário Mota Junior, 61 – 6º andar 01221-020 São Paulo, SP, Brasil. E-mail: kbribeiro@gmail.com