COVID-19's unseen impact: study reveals surge in home deaths across 32 countries

By Dr. Chinta SidharthanJan 5 2024Reviewed by Lily Ramsey, LLM

In a recent study published in The Lancet’s EClinicalMedicine, researchers examined changing trends in places of death across 32 countries during and before the coronavirus disease 2019 (COVID-19) pandemic to understand the larger impact of the pandemic on global mortality patterns and health.

Study: The rise of home death in the COVID-19 pandemic: a population-based study of death certificate data for adults from 32 countries, 2012–2021. Image Credit: Andrii Vodolazhskyi/Shutterstock.com

Background

The severity of the initial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and the lack of existing immunity or vaccines against the virus resulted in the COVID-19 pandemic levying an unexpected burden on healthcare systems worldwide.

The hospitals had to not only accommodate severe COVID-19 cases but also find ways to continue to care for critically ill patients, who were also at an increased risk of contracting SARS-CoV-2 infections.

The substantial mortality rates associated with COVID-19 also increased the burden on hospitals as they were compelled to accept more patients with severe SARS-CoV-2 infections.

On the other hand, families of critically ill patients also had to grapple with the whether to have the patients admitted to hospitals, given the high probability of contracting COVID-19 in the hospital and the visiting restrictions imposed due to the pandemic.

There were many reports of patients having died in the hospital without their families present. These pandemic-associated changes also impacted the trends in the place of death.

About the study

In the present study, the researchers used data from health authorities and national statistical offices of 32 countries on vital registration information such as death certificates to examine the trends in adult mortality regarding the place of death during the initial years of the COVID-19 pandemic between 2020 and 2021. They compared it to the trends observed in the eight years preceding the pandemic, from 2012 to 2019.

Reviews have shown that home is one of the most preferred places of death for patients with life-threatening illnesses and their families, with palliative care facilities and hospice being the next preferred options.

For many patients and their families, the autonomy, dignity, presence of loved ones and family members, comfort, and familiarity associated with home make it a preferred place to spend their last days.

However, deteriorating clinical conditions and the burden on caregivers also contribute to many patients not preferring to die at home.

Nonetheless, the personal preferences of patients and their families do not always align with reality, and the place of death is often also dependent on socioeconomic factors.

Based on the data available, the places of death were classified as home, hospital, non-hospital, and various other categories, since the data across countries were highly variable.

The data was aggregated based on age groups, sex, and cause of death, which included cancer, dementia, and COVID-19. The percentages and numbers of deaths were calculated according to place of death, sex, country, cause of death, and age groups.

The percentage of home deaths was plotted against time trends for the two years of the COVID-19 pandemic and the preceding eight years. The trends in place of death were also plotted for each country individually and based on the United Nations regions.

The percentage of home deaths was also calculated in an age-standardized manner to determine age distribution differences in home deaths.

Results

The results indicated an increase in the number of home deaths during the COVID-19 pandemic, but the percentage of home deaths varied considerably across numerous parameters, including age, country, cause of death, and sex.

The increase in the number of home deaths was higher among women than men, which the researchers attribute to a higher involvement of women in planning care towards the end of life and avoiding hospital admissions.

Although differences in home death percentages for different age groups were not consistent across countries, there was an increase in the number of home deaths due to cancer.

The researchers believe that, unlike non-malignant conditions, cancers have a more predictable trajectory of disease progression, and therefore, the increase in home deaths associated with cancers could be because of earlier and improved palliative care.

Only 8.3% of the overall deaths were due to COVID-19, suggesting that a significant portion of the home deaths were from other critical conditions for which palliative care was an option.

The study also discussed the role of rapidly expanding telemedicine in providing support and information to caregivers, enabling them to take care of patients at home, which could also have contributed to the increase in the number of home deaths.

Conclusions

Overall, the findings indicated that the COVID-19 pandemic resulted in a significant increase in the number of home deaths, but the trends varied across countries and age groups. Furthermore, the increase in home deaths was higher among women and cancer patients.

The researchers believe that the rapid expansion of telemedicine during the pandemic could have played a role in the increase in home deaths.