Medical resources and medical activities affect the rate of home death in cancer patients: Analysis by prefecture using Japanese National Database and public data

Abstract Background: In Japan, over half of the population, about 55.0%, hope to die at home, while 73.0% of the actual deaths are in hospitals. In particular, the hospital death rate for cancer, which is the leading cause of death, is even higher at 82.4%, which is also high internationally. Therefore, there is an urgent need to establish conditions for fulfilling the hopes of patients who hope to die at home, especially cancer patients. The aim of this study is to clarify the actual situation of home death in Japanese cancer patients and the influential factors related to home death. Methods: We used the National Database and public data. Japan's Ministry of Health, Labor and Welfare provides applicants with national data (National Database), big data related to medical services for research purposes. Using the National Database, we calculated the rate of home death by prefecture. In addition, we collected medical resources information and medical activities information from public data to clarify home death factors. Finally, we conducted a multiple regression analysis to investigate the home death rate factors. Results: During the study period from April 2017 to March 2018, we extracted 56,650 patients. We determined that the home death rate showed a specific difference by prefecture. There was a difference of about three times (14.3%-42.1%) between the maximum and minimum values. We also found that the activity of home-visit medical care by doctors is substantial as a factor to increase the rate of a home death (Standardized coefficient 0.586), and the number of acute care beds and the number of long-term care beds were significant factors to decrease the rate of home death (Standardized coefficient -0.334 and -0.220). Conclusions: Based on these results, it is essential to improve home-visit medical care activities in order to increase the home death in the future. By enhancing the activities of home-visit medical care, it is desirable to improve home-based palliative care and establish a system that enables cancer patients who want to die at home to realize it.