Introduction The majority of low-income and middle-income countries (LMICs) have incomplete death registration systems and so the proportion of deaths that occur at home (ie, home death percentage) is generally unknown. However, home death percentage is important to estimate population-level causes of death from integration of data of deaths at home (verbal autopsies) and in hospitals (medical certification), and to monitor completeness of death notification and verbal autopsy data collection systems. This study proposes a method to estimate home death percentage using data readily available at the national and subnational level. Methods Data on place of death from 152 country-years in 49 countries from 2005 to 2019, predominantly from vital registration systems, were used to model home death percentage standardised for population age and cause distribution. A national-level model was developed using Bayesian model averaging to estimate national, regional and global home death percentage. A subnational-level model was also developed and assessed in populations where alternative data on home death percentage were available. Results Globally, it is estimated that 53.4% (95% uncertainty interval (UI) 50.8%–55.9%) of deaths occur at home, slightly higher (59.7%, 95% UI 56.5%–62.7%) in LMICs, substantially higher in low-income countries (79.5%, 95% UI 77.3%–81.5%) and much lower (27.3%, 95% UI 25.2%–29.6%) in high-income countries. Countries with the highest home death percentage are mostly found in South, East and Southeast Asia and sub-Saharan Africa (above 90% in Ethiopia, Chad and South Sudan). As expected, the national model has smaller error than the subnational model. Conclusion The study demonstrates substantial diversity in the location of deaths in LMICs and fills a significant gap in knowledge about where people die, given its importance for health systems and policies. The high proportion of deaths in LMICs that occur at home reinforces the need for routine verbal autopsy to determine the causes of death. Data are available in a public, open access repository.

中文翻译：

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谁死在哪里？估计在家中发生的死亡百分比

引言 大多数低收入和中等收入国家 (LMIC) 的死亡登记系统不完整，因此在家中发生的死亡比例（即在家中死亡百分比）通常是未知的。然而，家庭死亡百分比对于通过整合家庭（口头尸检）和医院（医学证明）的死亡数据来估计人口水平的死亡原因以及监测死亡通知和口头尸检数据收集系统的完整性非常重要。本研究提出了一种使用国家和次国家级现成的数据来估计家庭死亡百分比的方法。方法 2005 年至 2019 年 49 个国家 152 个国家/地区的死亡地点数据，主要来自生命登记系统，用于模拟针对人口年龄和原因分布标准化的家庭死亡百分比。使用贝叶斯模型平均开发了一个国家级模型，以估计国家、区域和全球的家庭死亡率。还开发了一个国家以下级别的模型，并在可获得有关家庭死亡率的替代数据的人群中进行了评估。结果 在全球范围内，估计 53.4%（95% 不确定区间 (UI) 50.8%–55.9%）的死亡发生在家中，中低收入国家略高（59.7%，95% UI 56.5%–62.7%），显着高于低收入国家（79.5%，95% UI 77.3%–81.5%）和高收入国家低得多（27.3%，95% UI 25.2%–29.6%）。家庭死亡率最高的国家主要分布在南亚、东亚和东南亚以及撒哈拉以南非洲（埃塞俄比亚、乍得和南苏丹超过 90%）。正如预期的那样，国家模式比地方模式误差小。结论 鉴于其对卫生系统和政策的重要性，该研究表明中低收入国家的死亡地点存在很大差异，并填补了关于人们死亡地点的重大知识空白。在家中发生的中低收入国家的高比例死亡加强了对常规口头尸检以确定死因的必要性。数据可在公共、开放访问的存储库中获得。在家中发生的中低收入国家的高比例死亡加强了对常规口头尸检以确定死因的必要性。数据可在公共、开放访问的存储库中获得。在家中发生的中低收入国家的高比例死亡加强了对常规口头尸检以确定死因的必要性。数据可在公共、开放访问的存储库中获得。