Place of Death for People with Life-Limiting Illnesses in Malaysia: Trends (2005–2019) and Projections to 2030

BACKGROUND: Place of death (PoD) is an important component of end-of-life care as studies showed that home deaths are preferred among patients and caregivers. Studying trends in PoD is therefore essential to examine shifts in the distribution of PoD over time and inform decisions on future end-of-life care provision and policies. This study aimed to examine the past trends and future projections of PoD of patients with life-limiting illnesses in Malaysia. METHODS: We analysed decedents aged 15 years and above who died from life-limiting illnesses between 2005 and 2019 using national mortality registry. PoD was categorized as home, hospital, care home and other. Future PoD trends were projected to 2030 using simple linear modelling, accounting for projected changes in the age and sex distribution of deaths. Multinomial logistic regression model was used to assess factors associated with PoD. RESULTS: Between 2005 and 2019, 1,423,942 deaths were due to life-limiting illnesses; the most frequent cause was Alzheimer's disease, dementia and senility (37.0%, reflecting inclusion of non-medically certified senility deaths), followed by heart disease (22.9%) and malignant neoplasm (15.4%). The percentage of home deaths declined from 59.9% in 2005 to 49.2% in 2019. Contrastingly, percentages of hospital and care home deaths increased (35.1-45.2% and 0.6-1.1%). Based on current trend continuing, the proportion of home deaths is projected to decline further to 44.3% by 2030. Projection intervals were not calculated given the linear model assumptions; results should be interpreted as indicative trend extrapolations. Hospital deaths are projected to become the most common PoD and the largest proportion of deaths (48.3%). Decedents with Alzheimer's disease, dementia or senility had higher odds of dying at home than in hospital (AOR 31.66; 95% CI 31.14-32.19), while care home deaths were lower among females (AOR 0.85; 95% CI 0.82-0.89). CONCLUSIONS: This study demonstrated an increasing trend in hospital deaths, a reduction in home deaths over time; hospitals are projected to become the most common PoD by 2030. The projected increase in hospital deaths raises considerations regarding the future sustainability of inpatient end-of-life care. These findings suggest potential needs to strengthen community palliative care services to meet future end-of-life care needs.