Trends in place of death over a decade (2013-2024) in Belgium

Abstract Background Due to ageing population, more people require palliative care towards the end of life. Since most people would prefer to be cared for and to die at home, place of death is considered a quality indicator of end-of-life care. This study aims to examine trends in place of death over a decade (2013-2024) in Belgium. Methods Population-based mortality follow-back study with data collection through nationwide representative surveillance network (Belgian Sentinel General Practitioners Network). In 2013-2014 and 2022-2024, general practitioners (GPs) recorded the care in the last 3 months of life of every deceased patient (≥18 years) in their practice. Sudden deaths were excluded in this study. Time trends in the actual place of death were examined using multivariate logistic regression (with score test for linear trend of odds) adjusted for sex and age. Results Between 2013-2024, 1996 non-sudden deaths were registered by GPs. Over the last decade, 23% of deaths occurred at home (including death with relatives or in service flat) with no significant trend observed over time. Deaths in care homes increased from 37% (2013) to 44% (2024) with a significant increasing trend (p<.01). Hospital deaths (excluding palliative unit in a hospital) decreased from 29% (2013) to 20% (2024) (OR 0.61 (0.39-0.96)) with a significant decreasing trend (p<.05). Over the years 2013-2024, 9% of deaths occurred in the palliative unit of a hospital with no significant evolution over time. The percentage of deaths occurring elsewhere increased from 1% (2013) to 4% (2024) (OR 7.27 (1.93-27.45)) with a significant increasing trend (p<.001). Conclusions Recent population-based data show an increasing trend in care home deaths and declining trend in hospital deaths over the past decade in Belgium. Care homes have become the main place of death and end-of-life-care. This study reveals the effectiveness of end-of-life-care resources in care homes in Belgium over the last decade. Key messages • During 2013-2024, the percentage of care home deaths increased significantly and care homes became the main place of death in Belgium over the last decade. • Recent knowledge on trends in place of death is important for public health policy aimed at improving quality of end-of-life care in Belgium.