Trends and Associated Factors in Place of Death Among Individuals with Cardiovascular Disease in China, 2008-2020

Background: Cardiovascular disease (CVD) is the leading cause of death (COD) in China. Understanding the characteristics of place of death (POD) among CVD deaths would be of great importance to improve quality of end-of-life care. Limited studies have reported the POD among CVD deaths, and little was known about the associated factors of hospital CVD deaths. Methods: By using data from National Mortality Surveillance System (NMSS) in China, this study presented the characteristics of POD distribution during 2008 and 2020. Afterwards, we used multilevel logistic regression to explore associated factors of hospital CVD deaths, quantify the magnitude to which the spatial variations of hospital CVD deaths could be explained by those associated factors. Findings: During 2008-2020, there were 7101871 CVD deaths collected by NMSS in China, with 77·13% home deaths and 18·49% hospital death. Shanghai (59·40%) had the highest percentage of hospital CVD deaths. Age, sex, ethnicity, marital status, education, occupation, underlying COD were significant influential factors of hospital CVD deaths. Spatial variations were shown at provincial level, with 33·88% of them were explained by factors at individual level. Interpretation: POD distribution among CVD patients remained stable and home was the leading POD. Demographics and socioeconomic status were important factors at individual level explained majority of spatial variations among hospital CVD deaths, and patients with acute CVD exacerbations tended to have lower probability dying in hospitals. A comprehensive approach of integrating clinical care and community- or home-based care to formulate long-term care system that supports informal care and provides care arrangement options concerning cultural background should be emphasized to improve the quality of end-of-life care in China. Funding Information: National Key Research & Development Program of China (grant number 2018YFC1315301). Declaration of Interests: We declare no competing interests.