Characteristics influencing location of death for children with life-limiting illness

Objective To determine whether demographic and diagnostic characteristics were associated with location of death in a series of children with life-limiting illnesses. Design A population-level case series was carried out by reviewing mortality records. Sociodemographic characteristics, diagnosis and referral to paediatric palliative care (PPC) were analysed for association with location of death. Setting New Zealand Participants Children and young people aged 28 days-18 years who died from a life-limiting illness between 2006 and 2009 inclusive. Main outcome measures Location of death-home, hospital, other. Results Of 494 deaths, 53.6% (256/494) died in hospital and 41.9% (203/494) died at home. Asian (OR=2.66, 95% CI 1.17 to 6.04) and Pacific children (OR=2.22, 95% CI 1.15 to 4.29) had an increased risk of death in hospital compared with European children, while children with cancer (adjusted OR=0.48, 95% CI 0.3 to 0.75) and children referred to the PPC service (adjusted OR=0.60, 95% CI 0.38 to 0.96) had a decreased risk. Population-attributable risk for referral to the PPC service was 28.2% (95% CI 11.25 to 47.75). Conclusions Most children in New Zealand with a lifelimiting illness die in hospital with a significant influence resulting from ethnic background, diagnosis and referral to the PPC service. These findings have implications for resourcing PPC services and end-of-life care.