International differences in the technical qualities of place of death classifications and data: A survey of researchers’ perspectives

BACKGROUND: Place of death is a key population-level indicator for palliative care and health services planning. However, substantial international variation in how it is recorded limits cross-country comparisons and health system evaluations. AIM: Analyse the technical qualities of national place of death classifications and data, and identify strengths and weaknesses from the perspective of researchers using death certificate data. DESIGN: Cross-sectional online survey. The questionnaire design was informed by the United Nations (UN) and World Health Organization (WHO) recommendations for international statistical and health classifications, and included closed- and open-ended questions. SETTING/PARTICIPANTS: Sixteen researchers identified through published place of death studies participated. Collectively, they had analysed data from 67 countries until 2022, most for over 10 years. RESULTS: Most researchers reported that national classifications were stable, had mutually exclusive categories, and included a category for "home". However, shortcomings were identified: lack of detailed categories for relevant settings (e.g. hospice, nursing home), ambiguous or inconsistent terminology, and limited use of hierarchical or multi-axial structures. Participants emphasised the need for greater standardisation of categories, clearer definitions, and improved data quality through training on completing death certificates. CONCLUSIONS: This is the first study to assess place of death classifications and data from researchers' perspectives. Findings highlight critical limitations in current classification systems and provide guidance for developing an international classification aligned with UN and WHO recommendations. This will enable more meaningful cross-country comparisons and strengthen evidence to inform palliative care and health services planning worldwide.