The impact of urbanization on the place of death of older adults in China from an interprovincial perspective

Abstract

Abstract Background The place of death is an important measure of death quality. This study aimed to analyse the distribution and changes in the place of death of elderly individuals in China from an interprovincial perspective and its intrinsic association with rapid urbanization.Methods A hierarchical logistic model was constructed to carry out the analysis, using a combination of micro data from the China Health Influence Tracking Survey on the Elderly (CLHLS) 2011, 2014, and 2018 death samples and macro data at the provincial level from the China Statistical Yearbook.Results From 2011–2018, 95.04% of older Chinese adults died at home in rural areas, while 81.53% in urban areas. The overall hospital dying ratio of older adults first increased and then decreased, with the hospital dying ratio of urban older adults showing a significant downwards trend and rural older adults showing a slow upwards trend. The higher the number of medical beds per 10,000 people, the more likely the urban elderly are to die in hospitals. The higher the number of community general practitioners per 10,000 people, the more likely the urban elderly are to die at home. Older adults who were bedridden before death were more likely to die in a hospital, it was negatively moderated by the number of physician assistants per 10,000 population. Older adults with lower income were more likely to die at home, it was negatively moderated by the number of community health posts per 10,000 people.Conclusions Chinese older adults mainly die at home, especially in rural areas. The place of death of the urban elderly has become "deinstitutionalized", while rural elderly individuals are still in the stage of transition from home to the hospital. In urban China, the positive effect of regional medical care level on hospital dying and the positive effect of community medical resources on home dying occur simultaneously. Improvements at the regional medical level can increase the accessibility of medical services for older adults with certain mobility abilities and increase their probability of dying in the hospital. The abundance of community medical resources can alleviate the inequality of medical care utilization caused by the income disparity of elderly individuals.