Where a cancer patient dies: The effect of rural residency

Context: Surveys indicate 50% to 80% of cancer patients would choose to die at home if possible, although far fewer actually do. In Nova Scotia (NS), cancer deaths occurring out-of-hospital increased from 19.8% in 1992 to 30.2% in 1997. The impact of rural residency on this trend has not been studied. Purpose: To determine the association between dying of cancer in a rural locale and the likelihood of it being an out-of-hospital death. Methods: Secondary analysis of linked population-based administrative health data files. Subjects were all Nova Scotians who died of cancer from 1992 to 1997. Measures included location of death, dichotomized as a hospital death or an out-of-hospital death; and urban-rural residency, using an enumeration area urban-rural indicator created from postal code information adjusted for individual characteristics. Results: Of the 13,652 total cancer deaths, 6,171 occurred in rural NS, of which 1,471 (23.8%) died out-of-hospital. Out-of-hospital deaths in rural NS increased from 16.2% in 1992 to just over 27% in 1997. Compared with urban cancer patients, the adjusted odds of an out-of-hospital death in rural NS was lower (adjusted odds ratio, 0,87; 95% confidence interval, 0.79-0.95). Conclusions: There was an increasing trend during the 1990s for cancer patients to die out-of-hospital. Compared with their urban counterparts, patients in rural areas were less likely to do so. Those with cancer living in the rural setting who wish to die at home may face unique challenges.