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Maria J. Silveira, MD, MA, MPH, Laurel A. Copeland, PhD, MPH and Chris Feudtner, MD, PhD, MPH

Maria J. Silveira is with the VA Health Services Research and Development Center of Excellence, VA Ann Arbor Healthcare System, Ann Arbor, and the Division of General Medicine and the Bioethics Program, University of Michigan, Ann Arbor. Laurel A. Copeland is with the South Texas Veterans Health Care System VERDICT Research Program, San Antonio, and the Department of Psychiatry, University of Texas Health Science Center, San Antonio. Chris Feudtner is a member of the Pediatric Advanced Care Team, The Children’s Hospital of Philadelphia, Philadelphia, Pa, the Pediatric Generalist Research Group, Department of Pediatrics, Center for Bioethics, Leonard Davis Institute, Philadelphia, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia.

Correspondence: Requests for reprints should be sent to Maria J. Silveira, 300 North Ingalls Building, Room 7C27, Box 0429, Ann Arbor, MI 48109-0429 (e-mail: mariajs{at}umich.edu).

Objectives. We tested whether local cultural and social values regarding the use of health care are associated with the likelihood of home death, using variation in local rates of home births as a proxy for geographic variation in these values.

Methods. For each of 351110 adult decedents in Washington state who died from 1989 through 1998, we calculated the home birth rate in each zip code during the year of death and then used multivariate regression modeling to estimate the relation between the likelihood of home death and the local rate of home births.

Results. Individuals residing in local areas with higher home birth rates had greater adjusted likelihood of dying at home (odds ratio [OR]=1.04 for each percentage point increase in home birth rate; 95% confidence interval [CI] = 1.03, 1.05). Moreover, the likelihood of dying at home increased with local wealth (OR=1.04 per $10000; 95% CI=1.02, 1.06) but decreased with local hospital bed availability (OR=0.96 per 1000 beds; 95% CI=0.95, 0.97).

Conclusions. The likelihood of home death is associated with local rates of home births, suggesting the influence of health care use preferences.

This article has been cited by other articles:

				J. M. Linton and C. Feudtner What Accounts for Differences or Disparities in Pediatric Palliative and End-of-Life Care? A Systematic Review Focusing on Possible Multilevel Mechanisms Pediatrics, September 1, 2008; 122(3): 574 - 582. [Abstract] [Full Text] [PDF]