All‐cause mortality rates and home deaths decreased in children with life‐limiting diagnoses in Denmark between 1994 and 2014

Abstract

Aim Specialised paediatric palliative care has not previously been a priority in Denmark. The aim of this study was to support its development and organisation, by examining why and where children died using official national data for 1994–2014. Methods We obtained data on 9462 children who died before the age of 18 from the Danish Register of Causes of Death. The causes of deaths were listed according to the codes in the International Classification of Diseases. Results The all‐cause mortality rate decreased by 52% over the study period, and infants below one year accounted for 61% of all deaths. The decline in infant mortality (26%) primarily reflected fewer deaths due to congenital malformations and chromosomal abnormalities (68%) and perinatal deaths (30%). In children aged one year to 17 years, the substantial decrease (65%) was due to external causes (75%) and neoplasms (57%). The relative proportion of hospital deaths increased, while home deaths decreased. Conclusion All‐cause mortality rate decreased markedly, and the relative proportion of hospital deaths increased. The results may reflect more aggressive and effective treatment attempts to save lives, but some terminally ill children may be deprived of the option of dying at home.

Too much? Mortality and health service utilisation among Danish children 1999-2016: A register-based study

“…This means that an increased proportion of infant mortality takes place at the hospital [1]. The distinction between pre- and post-discharge mortality is also made more relevant by the fact children with life-threatening illness at birth often survive the neonatal age, and thus the conventional neonatal and post-neonatal mortality rates are no longer suited to distinguish between the mortalities related to perinatal health on one side and infant health on the other.…”

“…In Denmark the under-five mortality rate is approaching the absolute zero [1]. Since decreasing mortality reflects improved health, this is a success.…”

Highlights in this issue

“…Readers may also be interested in the paper by Lykke et al. on child mortality rates in Denmark, which we published in 2018, and the accompanying editorial by Kreicbergs , who discussed why and where children die.…”

Why and where do children die?

“…Lykke et al noted that home deaths among children aged 8–14 remained stable over the study period, but decreased among children aged four to seven years, as reflected by the substantial increase in hospital deaths. Although this may suggest that older children had a greater say about where to die, there are no data on children's preferred locations.…”

“…These issues are addressed in an interesting study by Lykke et al in this issue of Acta Paediatrica . The authors analysed why and where children died in Denmark from 1994 to 2014.…”