# Mortality from malignant neoplasms at home and in hospitals in Brazil, 2002-2022: sociodemographic characteristics and temporal trends

## TL;DR

This study examines cancer-related deaths in Brazil from 2002 to 2022, analyzing trends and sociodemographic factors associated with deaths occurring at home versus in hospitals.

## Contribution

The study identifies sociodemographic patterns and regional trends in cancer mortality locations, highlighting disparities and increasing trends nationwide.

## Key findings

- 82.5% of cancer deaths in Brazil occurred in hospitals, with home deaths more common among older, less-educated, and Indigenous populations.
- The Northeast and South regions had the highest rates of home mortality, while the Southeast and South had the highest hospital mortality.
- Both home and hospital cancer deaths showed increasing trends across most Brazilian states from 2002 to 2022.

## Abstract

To analyze the sociodemographic characteristics and temporal trends of deaths due to malignant neoplasms in Brazil, according to whether they occurred at home or in a hospital, from 2002 to 2022.

This is a descriptive and ecological study analyzing data on cancer deaths from the Brazilian Mortality Information System. The analysis included descriptive measures, mortality rates, and trends based on joinpoint regression of sociodemographic variables, according to the place of death, as well as associations with the occurrence at home or in hospitals.

We analyzed a total of 3,696,553 cancer deaths in Brazil, of which 82.5% occurred in hospitals. The variables positively associated with deaths at home were: men, age between 70 and 79 years and 80 years or older, mixed-race and Indigenous ethnicity, no formal education and one to three years of formal education, and widowed or other marital status. The Northeast and South regions had the highest rates of home mortality, while the Southeast and South regions led in hospital mortality. There was an increasing trend for both deaths occurring at home and those in hospitals nationwide. In the evaluation of home deaths, an increasing trend was observed in nine states and in the Federal District. Regarding hospital deaths, all Brazilian states showed an increasing trend.

The factors that influence the place of death for cancer patients are complex and include support network, access, culture, and the use of healthcare services. Targeted actions for more vulnerable populations and locations are necessary to reverse the growing trend of this condition.

Analisar as características sociodemográficas e as tendências temporais dos óbitos por neoplasias malignas no Brasil, segundo a ocorrência em domicílio ou hospital, no período de 2002 a 2022.

Estudo descritivo e ecológico que analisou dados sobre óbitos por neoplasias do Sistema de Informação sobre Mortalidade. A análise incluiu medidas descritivas, taxas de mortalidade e tendências por regressão joinpoint de variáveis sociodemográficas, conforme o local de óbito, além de associação com a ocorrência em domicílio ou hospital.

Analisaram-se 3.696.553 óbitos por neoplasias no Brasil, dos quais 82,5% ocorreram em hospitais. Associaram-se positivamente à ocorrência em domicílio as variáveis: sexo masculino, idade entre 70 e 79 anos e 80 anos ou mais, raça/cor parda e indígena, ausência de estudo e tempo de estudo entre um e três anos, e estado civil viúvo ou outro. As regiões Nordeste e Sul tiveram as maiores taxas de mortalidade domiciliar, enquanto Sudeste e Sul lideraram na hospitalar. Houve tendência crescente tanto para os óbitos ocorridos em domicílio quanto para aqueles em hospital no país. Na avaliação dos óbitos ocorridos em domicílio, notou-se tendência de incremento em nove estados e no Distrito Federal. No que se refere aos óbitos em hospital, todas as unidades da federação registraram tendência crescente.

Os fatores que influenciam o local de morte de pessoas com câncer são complexos e incluem rede de apoio e acesso e disponibilidade de serviços de saúde. Ações direcionadas a públicos e locais mais vulneráveis são necessárias para reverter o cenário ascendente desse agravo.