Distribution and trend of deaths within the hospital environment in Spain during the 1997-2003 period

BACKGROUND: Where a person's death occurs depends upon situations of a demographic, socioeconomic, cultural and healthcare-related nature. The objective of this study was that of describing the variations in the percentages of deaths in hospitals among the Autonomous Communities of Spain, distinguishing between those which occurred in emergency care and during hospitalization and delving into their relation with variables possibly providing an explanation thereto. METHODS: The study was an ecological one, the trend in the percentage of deaths in hospitals within the 1997-2003 period having been studied. The percentages of deaths in hospitals from each Autonomous Communities during the 2000-2002 period were calculated based on the Natural Population Movement and the Survey of In-Patient Healthcare Establishments which includes information from all of the public and private hospitals. The relationship thereof to demographic, socioeconomic and healthcare-related variables was analyzed by single linear regression. RESULTS: A total of 53% of the deaths occurred in hospitals (ranging from 37.3% to 68.4% in the different Autonomous Communities). A total of 10.7% of the deaths occurred in emergency care (ranging from 6% to 14.5%) and all others during hospitalization. CONCLUSIONS: The percentage of deaths having occurred in hospitals was greater in the Autonomous Communities having a smaller elderly rural population, a larger foreign population and a higher degree of frequenting of emergency care. The percentage of hospital deaths in emergency care was greater in those Autonomous Communities having poorer socioeconomic indicators. The trend over the seven years studied was toward a rise in the percentage of deaths in hospitals.