Changing Mortality and Place of Death in Response to Refugee Influx: A Population-Based Cross-Sectional Study in Jordan, 2005–2016

Summary

Background

Jordan faces complex health care challenges due to refugee influx and an aging population. Palliative care planning and delivery require data to ensure services respond to changing population needs.

Aim/objectives

To determine the trend in mortality and place of death in Jordan.

Methods

This study is a population-based study utilising death registry data of adult decedents (n = 143,215), 2005–2016. Descriptive statistics examined change in demographic and place of death (categorized as hospital and nonhospital). Binomial logistic regression compared the association between hospital deaths and demographic characteristics in 2008–2010, 2011–2013, and 2014–2016, with 2005–2007.

Results

The annual number of deaths increased from 6792 in 2005 to 17,018 in 2016 (151% increase). Hospital was the most common place of death (93.7% of all deaths) in Jordan, and percentage of hospital deaths increased for Jordanian (82.6%–98.8%) and non-Jordanian decedents (88.1%–98.7%). There was an increased likelihood of hospital death among Jordanian decedents who died from nonischemic heart disease (odd ratio [OR]: 1.11, 95% confidence interval [CI]: 1.09–1.13, p < 0.001), atherosclerosis (OR: 1.10, 95% CI: 1.08–1.13, p < 0.001), renal failure (OR: 1.05, 95% CI: 1.02–1.08, p < 0.001), hemorrhagic fevers (OR: 1.09, 95% CI: 1.06–1.13, p < 0.001), and injury (OR: 1.18, 95% CI: 1.06–1.33, p < 0.001) in the period 2014–2016, compared with 2005–2007. There were similar increases in the likelihood of hospital death among non-Jordanians in 2014–2016 for the following conditions: malignant neoplasms (except leukemia), nonischemic heart disease, atherosclerosis, injury, and HIV, compared with 2005–2007.

Conclusion

Country-level palliative care development must respond to both internal (aging) and external (refugee influx) population trends. Universal Health Coverage requires palliative care to move beyond cancer and meet population-specific needs. Community-based services should be prioritized and expanded to care for the patients with nonischemic heart disease, atherosclerosis, renal failure, hemorrhagic fevers, and injury.

Outputs 

1. Guo P, Chukwusa E, Asad M, et al. Changing mortality and place of death in response to refugee influx: a population-based cross-sectional study in Jordan, 2005-2016. Journal of Palliative Medicine 2021; https://doi.org/10.1089/jpm.2020.0476