Location of death among children with life-threatening conditions: a national population-based observational study using the Canadian Vital Statistics Database (2008–2014)

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Figure 1:
Flow diagram. *External causes of death included accidents, assault, suicide or drowning (International Classification of Diseases, 10th Revision [ICD-10] codes from V01 to Y36), or sudden infant death syndrome (R95). ^†Examples of causes of death other than life-threatening conditions included ill-defined or unknown causes (R99.9), depressive episodes (F32), influenza and pneumonia (J09–J18), asthma (J45–46) and infectious and parasitic diseases (A00–B99).

Table 1:

Characteristics of study cohort

Characteristic	No. (%) of decedents^*
Characteristic	Older children (aged 29 d–19 yr) n = 5250	Neonates (aged < 29 d) n = 7865
Age
< 24 h	–	5285 (67.2)
24 h–28 d	–	2580 (32.8)
29–364 d	1700 (32.4)	–
1–4 yr	980 (18.7)	–
5–9 yr	665 (12.7)	–
10–14 yr	745 (14.2)	–
15–19 yr	1150 (22.0)	–
Sex
Male	2440 (53.5)	4270 (54.3)
Female	2810 (46.5)	3595 (45.7)
Cause of death^†
Perinatal	305 (5.8)	4865 (61.9)
Congenital	1455 (27.7)	2690 (34.2)
Oncology	1345 (25.6)	60 (0.8)^†
Hematology	120 (2.3)	60 (0.8)^†
Neurology	980 (18.7)	45 (0.6)
Metabolic	345 (6.6)	65 (0.8)
Circulatory	330 (6.3)	40 (0.5)
Respiratory	195 (3.7)	100 (1.3)^†
Gastrointestinal	95 (1.8)
Genitourinary	55 (1.1)
Other	30 (0.6)
Province or region^‡
Ontario	2055 (39.1)	3240 (41.2)
Quebec	1095 (20.9)	2035 (25.9)
Alberta	675 (12.9)	1015 (12.9)
Prairies	520 (9.9)	600 (7.6)
British Columbia	540 (10.3)	570 (7.3)
Atlantic	320 (6.1)	350 (4.5)
North	45 (0.9)	55 (1.5)
Income quintile
1 (lowest)	1210 (23.4)	2055 (26.7)
2	1025 (19.8)	1530 (19.9)
3	1000 (19.3)	1490 (19.3)
4	1050 (20.3)	1520 (19.7)
5 (highest)	890 (17.2)	1110 (14.1)
Rurality
Urban	4085 (78.3)	6330 (81.7)
Rural^§	1135 (21.7)	1420 (18.3)
Distance from pediatric hospital, km
< 50	2855 (54.8)	4700 (60.7)
50–199	1460 (28.0)	1910 (24.7)
200–400	575 (11.0)	645 (8.3)
> 400	325 (6.2)	485 (6.3)
Location of death^¶
Hospital	3895 (74.2)	7715 (98.1)
Home	845 (16.1)	60 (0.8)
Other health care facility	150 (2.9)	30 (0.4)
Other location	360 (6.9)	60 (0.8)

Note: ICD-10 = International Classification of Diseases, 10th Revision.
↵* Numbers may not add to total cohort size because of missing data. Some categories combined to avoid small cell sizes.
↵† Please see Appendix 1 for a complete list of included conditions for each category.
↵‡ Prairies included Manitoba and Saskatchewan. Atlantic included Newfoundland and Labrador, Prince Edward Island, Nova Scotia and New Brunswick. North included Northwest Territories, Yukon and Nunavut.
↵§ Population < 10 000.
↵¶ Hospitals included facilities licensed to operate as a hospital under provincial, territorial or federal government legislation. Other health care facilities included community health centres, freestanding birthing centres, and nursing and residential care facilities. Other locations might include a school, outdoors, at a park or on route to a hospital.

Table 2:

Multivariable logistic regression of factors associated with death in hospital among children (aged 29 d–19 yr), n = 5250^*

Characteristic	OR (95% CI)
Age
15–19 yr	Ref.
10–14 yr	0.95 (0.77–1.17)
5–9 yr	0.66 (0.54–0.82)
1–4 yr	0.88 (0.72–1.07)
29–364 d	1.73 (1.40–2.15)
Sex
Male	Ref.
Female	1.06 (0.93–1.21)
Cause of death
Oncology	Ref.
Congenital	1.74 (1.43–2.11)
Neurology	1.07 (0.90–1.28)
Metabolic	1.12 (0.86–1.46)
Circulatory	2.73 (1.96–3.79)
Perinatal	2.78 (1.84–4.21)
Respiratory	3.37 (2.15–5.31)
Hematology	2.52 (1.49–4.26)
Gastrointestinal	5.36 (2.54–11.30)
Genitourinary	3.44 (1.43–8.26)
Other	3.34 (1.15–9.68)
Region of residence
Ontario	Ref.
Quebec	1.38 (1.14–1.67)
Alberta	1.03 (0.83–1.27)
Prairies	1.27 (0.98–1.63)
British Columbia	0.43 (0.34–0.53)
Atlantic	1.02 (0.76–1.37)
North	0.49 (0.23–1.05)
Income quintile
5 (highest)	Ref.
4	1.08 (0.88–1.33)
3	1.07 (0.87–1.32)
2	1.23 (0.99–1.52)
1 (lowest)	1.59 (1.28–1.97)
Rurality
Urban	Ref.
Rural	0.98 (0.81–1.18)
Distance from pediatric hospital, km
< 50	Ref.
50–199	0.73 (0.62–0.86)
200–400	0.87 (0.68–1.11)
> 400	0.73 (0.65–0.86)

Table 3:

Multivariable logistic regression examining factors associated with death in hospital among neonates (aged < 29 d), n = 7865^*

Characteristic	OR (95% CI)
Age
< 24 hr	13.01 (7.94–21.32)
24 hr–28 d	Ref.
Sex
Male	Ref.
Female	0.75 (0.53–1.05)
Cause of death
Perinatal	Ref.
Congenital	0.25 (0.17–0.36)
All other causes	0.47 (0.24–0.92)
Region of residence
Ontario	Ref.
Quebec	1.36 (0.79–2.34)
Alberta	0.53 (0.31–0.88)
Prairies	0.97 (0.49–1.92)
British Columbia	0.30 (0.19–0.49)
Atlantic	1.54 (0.53–4.45)
North	0.27 (0.05–1.42)
Income quintile
5 (highest)	Ref.
4	1.24 (0.70–2.18)
3	1.33 (0.75–2.35)
2	1.57 (0.88–2.83)
1 (lowest)	1.16 (0.69–1.94)
Rurality
Urban	Ref.
Rural	0.73 (0.45–1.19)
Distance from pediatric hospital, km
< 50	Ref.
50–199	0.66 (0.43–1.01)
200–400	1.08 (0.56–2.12)
> 400	0.89 (0.41–1.94)