Places of death and changing trends of residents in Hunan province from 2014 to 2023: an analysis based on cause-of-death surveillance data

Objective  To understand the changing trends of places of death among residents in Hunan province from 2014 to 2023 and provide an empirical basis for constructing a hospice care service system in line with national conditions.

Methods The cause-of-death surveillance data of Hunan province from 2014 to 2023 were collected. The 2020 Hunan census data were taken as the standard population to calculate the age-standardized composition ratio of the places of death. The Joinpoint regression model was adopted to analyze the changing trend of different places of death.

Results From 2014 to 2023, 81.18% of the registered deaths in Hunan province were dying at home, with an average annual increase of 0.40% (AAPC = 0.40%, P < 0.001). The ratio of death in hospitals first decreased (2014–2017: APC =–2.49%, P = 0.020) and then increased (2017–2023: APC = 1.55%, P < 0.001). The ratio of death in nursing institutions increased by 8.59% annually (AAPC = 8.59%, P < 0.001). The ratio of death on the way to hospitals decreased by 4.32% annually (AAPC = –4.32%, P < 0.001). From 2014 to 2023, the ratio of death in rural hospitals in Hunan province was 8.52%, which differed from that (19.69%) in urban hospitals (χ² = 106 862.300, P < 0.001). The ratio of death in rural hospitals increased by 1.31% annually (AAPC = 1.31%, P < 0.001).

Conclusions Home is still the dominated place of death in Hunan province, while the ratios of death in hospitals and nursing institutions are rising rapidly. Future policies should balance resource equity and cultural adaptation and improve medical access while maintaining the diversity and dignity of end-of-life choices.