Factors Associated with Lower Rates of In-hospital Death

Objectives: Examine individual and statewide factors associated with hospital as location of death.

Design: An observational study using large national databases.

Participants: All 1997 U.S. decedents (all ages, all causes.)

Results: The West has the lowest percentage of deaths occurring in an acute care hospital, and the highest percentage of deaths at home. Increased hospital bed availability is significantly associated with greater chance of dying in an acute care hospital. Hispanic, nonwhite, and less educated decedents are more likely to die in a hospital (as opposed to home or nursing home).

Conclusions: Hospital bed availability profoundly influences the likelihood of dying in a hospital. Individual characteristics such as race and education affect location of death as well. These three factors account for approximately 75% of the trend in the West to a lower in-hospital death rate and more deaths at home. Additional factors may include formal out of hospital orders to limit transfer.