Predictors for place of death among children:A systematic review and meta-analyses of recent literature

Abstract

Through a systematic review and meta-analyses, we aimed to determine predictors for place of death among children. We searched online databases for studies published between 2008 and 2019 comprising original quantitative data on predictors for place of death among children. Data regarding study design, population characteristics and results were extracted from each study. Meta-analyses were conducted using generic inverse variance method with random effects. Fourteen cohort studies met the inclusion criteria, comprising data on 106,788 decedents. Proportions of home death varied between countries and regions from 7% to 45%. Lower age was associated with higher odds of hospital death in eight studies (meta-analysis was not possible). Children categorised as non-white were less likely to die at home compared to white (pooled OR 0.6; 95% CI 0.5–0.7) as were children of low socio-economic position versus high (pooled OR 0.7; 95% CI 0.6–0.9). Compared to patients with cancer, children with non-cancer diagnoses had lower odds of home death (pooled OR 0.5; 95% CI 0.5–0.5).

Conclusion: Country and region of residence, older age of the child, high socio-economic position, ‘white’ ethnicity and cancer diagnoses appear to be independent predictors of home death among children.

What is Known:
Home is often considered an indicator of quality in end-of-life care.
Most terminally ill children die in hospitals.
What is New:
Through a systematic review and meta-analyses, this study examined predictors for place of death among children.
• Country and region of residence, older age of the child, high socio-economic position, white ethnicity and having a cancer diagnosis appear to be independent predictors of home death among terminally ill children.

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Acknowledgements

We highly appreciate the support from Marianne Godt Hansen on language revision for this article.

Funding

This work was supported by M.L. Jørgensen og Gunnar Hansens Fond (the authors declare that they have no other financial relationship with this organisation).

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Authors

Contributions

S.L.W. conceptualised and designed the study, conducted literature searches, study selections and data extractions, and drafted the initial manuscript.

M.A.N. conceptualised and designed the study, conducted literature searches, study selections and data extractions, and reviewed and revised the manuscript.

C.F.C., M.K.N., S.P.J. and H.S. conceptualised and designed the study, reviewed and revised the manuscript.

All authors have approved the final manuscript and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Sanne Lausen Wolff.

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Communicated by Gregorio Paolo Milani

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Wolff, S.L., Christiansen, C.F., Nielsen, M.K. et al. Predictors for place of death among children:A systematic review and meta-analyses of recent literature. Eur J Pediatr 179, 1227–1238 (2020). https://doi.org/10.1007/s00431-020-03689-2

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Keywords

  • Child
  • Place of death
  • Palliative care
  • Systematic review