Urban residence, income source, and place of death among Chinese older adults.

Background: Place of death has received extensive interest among scholars, but research focusing on place of death among Chinese older adults is scarce. This study aimed to explore the associations between rural/urban residence, primary income source, and place of death among Chinese older adults.

Methods: The sample consists of 24,794 decedents (female = 60%, died at home = 88%, mean age at death = 95) from the 2002-2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). Chi-squared tests and binary logistic regression models were used to analyze relationships between residential area (urban vs. town or rural), income source (financial support from family vs. personal income), and place of death (home vs. hospitals or other healthcare settings).

Results: Decedents living in cities were 3.5 times more likely to die in hospitals or other healthcare settings than at home, and those who had personal income were 1.5 times more likely to die in healthcare settings than at home. Notably, the interaction between city and personal income were significant (P < 0.001). Older adults who both lived in cities and had personal income had the highest probability (83%) to die in healthcare settings.

Conclusions: Urban residence and having personal income were highly associated with dying in hospitals or other healthcare settings. As China urbanizes and expands its pension system, an increasingly higher percentage of deaths may happen in healthcare settings. This study alerts policymakers of the enormous pressures that the hospital-centered care system may face in the future. A home-based palliative care and hospice system may be needed to improve the incidence and experiences of patients dying at home.

Trial registration: Not applicable.