Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2025 May 2;15(1):15430.
doi: 10.1038/s41598-025-98589-6.

Impact of COVID-19 on place of death for disease-related causes: a population-based study in Nanchang, China

Huiting Chen  1   2 , Yibing Fan  3 , Hao Wu  1   2 , Yu Cao  1   2 , Fanyan Zeng  1   2 , Hui Liu  1   2 , Wei Gao  4   5
Affiliations
Observational Study

Impact of COVID-19 on place of death for disease-related causes: a population-based study in Nanchang, China

Huiting Chen et al. Sci Rep. .

Abstract

Little is known about the place of death at the regional level in China. Furthermore, the impact of COVID-19 on the place of death remains unclear. We aimed to examine the place of death before and during COVID-19 in Nanchang, China, focusing on changes in home death across different causes, to determine whether these changes were disproportionately experienced among patients with different diseases. Using data from the National Death Registration System, Nanchang, China, this population-based, observational study examined all non-accidental deaths from 1 January 2014 to 31 December 2019 (pre-COVID-19), and 25 January 2020 to 31 December 2022 (during COVID-19). Modified Poisson regression models were employed to assess the association between underlying cause of death and home death, and interaction terms added to evaluate changes over periods. We used R version 4.2.2 for all analyses. The analysis included 198,383 deaths, with a median age of 78 years (IQR: 66-85); 58.2% were male and 41.8% were female. Home deaths rose from 72.7% pre-COVID-19 to 75.6% during COVID-19 (p < 0.0007). Before COVID-19, patients with renal failure (adjusted PR 0.74 [95% CI, 0.67-0.81]), liver disease (0.81 [0.76-0.86]), and hematological cancer (0.88 [0.84-0.92]) were less likely to die at home compared to those with solid cancer. During COVID-19, these disparities diminished, with a significant increase in home deaths among renal failure (1.32 [1.19-1.48]), liver disease (1.19 [1.10-1.29]), and hematological cancer (1.12 [1.05-1.20]). The majority of non-accidental deaths occurred at home, with a notable rise during COVID-19, underscoring the urgent need to strengthen community- and home-based end-of-life care services. Although home death rates for patients with renal failure, liver disease, and hematological cancer were lower before COVID-19, they increased significantly during the pandemic, highlighting disparities in end-of-life care that necessitate targeted improvements.

Keywords: COVID-19; Cause of death; End-of-life care; Palliative care; Place of death.

PubMed Disclaimer

Conflict of interest statement

Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Number of deaths and proportion of home deaths in Nanchang 2014–2022.
See this image and copyright information in PMC

References

    1. Gao, W., Ho, Y. K., Verne, J., Gordon, E. & Higginson, I. J. Geographical and Temporal Understanding in place of death in England (1984–2010): analysis of trends and associated factors to improve end-of-life care (GUIDE_Care)—primary research. Health Serv. Deliv Res.2, 1–104 (2014). - PubMed
    1. Pinto, S., Lopes, S., de Sousa, A. B., Delalibera, M. & Gomes, B. Patient and family preferences about place of End-of-Life care and death: an umbrella review. J. Pain Symptom Manage.67, e439–e452 (2024). - PubMed
    1. Davies, J. M. et al. Socioeconomic position and use of healthcare in the last year of life: a systematic review and meta-analysis. PLOS Med.16, e1002782 (2019). - PMC - PubMed
    1. Leng, A. et al. Preferences for End-of-Life care among patients with terminal cancer in China. JAMA Netw. Open.5, e228788 (2022). - PMC - PubMed
    1. Cheng, Q. et al. Knowledge, attitudes and preferences of palliative and end-of-life care among patients with cancer in Mainland China: a cross-sectional study. BMJ Open.11, e051735 (2021). - PMC - PubMed

Publication types