Change in the Proportion of Death at Home during the COVID-19 Pandemic and Its Associated Factors in the Municipality Level: A Nationwide Study in Japan

Yu Sun; Masao Iwagami; Ryota Inokuchi; Nobuo Sakata; Tomoko Ito; Yuta Taniguchi; Satoru Yoshie; Nanako Tamiya

doi:10.31662/jmaj.2023-0165

Change in the Proportion of Death at Home during the COVID-19 Pandemic and Its Associated Factors in the Municipality Level: A Nationwide Study in Japan

JMA J. 2024 Apr 15;7(2):213-221. doi: 10.31662/jmaj.2023-0165. Epub 2024 Mar 18.

Authors

Yu Sun^{1

2

3}, Masao Iwagami^{1

3}, Ryota Inokuchi³, Nobuo Sakata^{1

4

5}, Tomoko Ito³, Yuta Taniguchi⁶, Satoru Yoshie^{3

7

8

9

10}, Nanako Tamiya^{1

3}

Affiliations

¹ Department of Health Services Research, Institute of Medicine, University of Tsukuba, Ibaraki, Japan.
² Department of Primary Care and Medical Education, Institute of Medicine, University of Tsukuba, Ibaraki, Japan.
³ Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan.
⁴ Heisei Medical Welfare Group Research Institute, Tokyo, Japan.
⁵ Department of Home Healthcare, Setagaya Memorial Hospital, Tokyo, Japan.
⁶ Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.
⁷ Institute of Gerontology, University of Tokyo, Tokyo, Japan.
⁸ Institute for Future Initiatives, University of Tokyo, Tokyo, Japan.
⁹ Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan.
¹⁰ School of Medicine, Hiroshima University, Hiroshima, Japan.

Abstract

Introduction: The coronavirus disease 2019 (COVID-19) pandemic may have led to an increase in home deaths due to hospital bed shortage and hospital visitation restrictions. This study aimed to examine changes in the proportion of home deaths before and after the COVID-19 pandemic and identify associated factors.

Methods: We used publicly available nationwide data to describe the proportion of home deaths among total deaths from 2015 to 2021. Furthermore, we used municipal-level data to examine the factors associated with the increase in the proportion of home deaths from 2019 to 2021. The dependent variable was the absolute change in the proportion of home deaths from 2019 to 2021. The independent variables included each municipality's 2019 home death percentage, medical and long-term care (LTC) resources divided by the population of older people, population density, and cumulative number of COVID-19 cases. A multivariable linear regression analysis was conducted after the standardization of each variable.

Results: The proportions of home deaths in 2015, 2019, and 2021 were 12.7%, 13.6%, and 17.2%, respectively, indicating a sharp increase in home death rate after the COVID-19 pandemic. In the multivariable linear regression analysis that included 1,696 municipalities, conventional home care support clinics and hospitals (HCSCs) (coefficient [95% confidence intervals (CIs)], 0.19 [0.01-0.37]), enhanced HCSCs (0.53 [0.34-0.71]), home-visiting nurses (0.26 [0.06-0.46]), population density (0.44 [0.21-0.67]), and cumulative COVID-19 cases (0.49 [0.27-0.70]) were positively associated with the increase in home deaths, whereas beds of LTC welfare facilities (-0.55 [-0.74--0.37]) and the proportion of home deaths in 2019 (-1.24 [-1.44--1.05]) were negatively associated with the increase.

Conclusions: During the COVID-19 pandemic, home deaths significantly increased, particularly in densely populated areas with high cumulative COVID-19 cases. HCSCs, especially enhanced HCSCs, are crucial for meeting the demand for home-based end-of-life care.

Keywords: COVID-19; home deaths; home healthcare services.