Maria J. Silveira ¹, Laurel A. Copeland ², Chris Feudtner ^3*

¹ University of Michigan
² South Texas Veterans Health Care System
³ Children's Hospital of Philadelphia

^* To whom correspondence should be addressed. E-mail: feudtner{at}email.chop.edu.

	Abstract

Objectives. We tested whether local cultural and social values regarding the use of health care are associated with the likelihood of home death, using variation in local rates of home births as a proxy for geographic variation in these values.

Methods. For each of 351110 adult decedents in Washington state who died from 1989 through 1998, we calculated the home birth rate in each zip code during the year of death, and then used multivariate regression modeling to estimate the relation between the likelihood of home death and the local rate of home births.

Results. Individuals residing in local areas with higher home birth rates had greater adjusted likelihood of dying at home (odds ratio [OR]=1.04 for each percentage point increase in home birth rate; 95% confidence interval [CI]=1.03, 1.05). Moreover, the likelihood of dying at home increased with local wealth (OR=1.04 per $10 000; 95% CI=1.02, 1.06) but decreased with local hospital bed availability (OR=0.96 per 1000 beds; 95% CI=0.95, 0.97).

Conclusions. The likelihood of home death is associated with local rates of home births, suggesting the influence of health care use preferences.

Key Words: Epidemiology, Geography, Health Policy, Health Service Delivery

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