Whether you die in hospital or your own home can depend on where you live, your age, gender, cause of death and socio-economic factors, according to research published today by the National End of Life Care Intelligence Network (NEoLCIN).

The report – Variations in Place of Death in England: Inequalities or appropriate consequences of age, gender and cause of death? – reveals big variations in the percentage of deaths that occur in hospital – both between the English regions and at a local authority level.

It also shows that people on low incomes are more likely to die in hospital, with 62% of deaths amongst people in the most deprived quintile of the population occurring in hospital. Amongst the most affluent fifth of the population the figure is 55%.

The report cautions however that these inequalities might reflect a greater incidence of diseases requiring hospital care at the terminal stage amongst people in lower socio-economic groups.

It confirms that nationally 58% of deaths occur in hospitals, while just 19% of deaths occur at home. London has the highest proportion of deaths in hospital (65.7%) and the south west the lowest (53.7%). London also has the lowest proportion of people dying at home (17.6%) and the north east the highest, at 20.5%.

The difference is even starker at a local authority level: 78.1% of deaths in the London borough of Waltham Forest occur in hospital compared to 44.6% in Torbay. South Cambridgeshire has the highest proportion of deaths at home (27%) – nearly double that of Hertsmere and the London borough of Kingston upon Thames, both of which recorded 13.7%.

Dr Linda Charles-Ozuzu, NEoLCIN’s national programme manager, said: “This report provides the first comprehensive picture of the wide range of factors that affect where people die in England. Future reports will examine the issues raised here in more detail.”

NEoLCP director Claire Henry said: “This data is interesting in itself but now it must be used on the ground to improve end of life care services for people nearing the end of life, their families and carers. Some of the factors contributing to relatively high rates of deaths in hospitals are beyond the immediate control of commissioners and providers. Others are not. This research must be used to shape services that ensure more people die in the setting they choose regardless of where they live.”

Lead author of the report and director of the South West Public Health Observatory, Dr Julia Verne, said: “This report challenges our assumptions about how best to provide care at the end of life. It shows that a wide range of factors need to be taken into account when planning and commissioning care and highlights equality as a priority issue.”

Dr Verne said it is important to note that if deaths in care homes are included, the percentage of deaths occurring at home would rise from 19% to 34.7%.

Other key findings include:

• Men over 85 in the most deprived fifth of the population are most likely to die in hospital (66.2% of deaths in this group occur in hospital)
• Those least likely to die in hospital are women over 85 in the most affluent two-fifths of the population (50%) and men under 65 from the most affluent fifth (51%)
• Cardiovascular disease is the most common cause of death in hospital (90,618 deaths per year on average; 33%)
• 69% (45,193) of people with respiratory disease die in hospital
• 48% (62,577) of people who die as a result of cancer die in hospital, compared with 17% (22,228) in hospices and 24% (30,920) at home.