Place of death and healthcare utilisation at the end of life among individuals with mental and behavioural disorders as underlying cause of death: population-level multiple-register study.

Background: Understanding the place of death for individuals with mental and behavioural disorders (MBDs) is essential for identifying disparities in healthcare access and outcomes, as well as addressing broader health inequities within this population.

Aims: To examine the place of death among individuals in Sweden with the underlying cause of death reported as a MBD and compare variations between diagnostic groups, as well as explore associations between place of death and individual, sociodemographic and clinical factors.

Method: This population-level analysis used death certificate data (gender, age, underlying cause of death and place of death) recorded between 2013 and 2019 and other national register data. MBD group differences were compared using chi-square tests (χ) and multinominal logistic regressions explored variations in place of death.

Results: The final sample consisted of 2875 individuals. Our regression model revealed that individuals with MBDs other than intellectual disabilities were less likely to die in hospitals (odds ratio 0.60-0.134 [95% CI = 0.014-0.651]) or care homes (odds ratio 0.11-0.97 [95% CI = 0.003-0.355]) than at home. Substance use disorders were the most common underlying cause of death (61.3%). This group consisted predominantly of men (78.8%, χ, < 0.001), and tended to be younger (χ, < 0.001).

Conclusions: Individuals with intellectual and developmental disabilities are more likely to die in hospitals or care homes than at home. Those with MBDs, particularly substance use disorders, face a high risk of premature death, highlighting gaps in healthcare and palliative care provision for these populations.