Trinity College Dublin: New research reveals where and how people die in Ireland

Researchers at Trinity College Dublin have launched the ‘Dying and Death in Ireland: what do we routinely measure, how can we improve?’ Report, 2021. The report details findings from a Health Research Board (HRB) funded study on how and where people died in Ireland between 2013 and 2018. It also reports on the type and quality of data on death and dying that are available in Ireland.

The study was conducted in collaboration with Irish Hospice Foundation (IHF) with support from the All Ireland Institute of Hospice and Palliative Care (AIIHPC) and the Health Service Executive (HSE).

Cancer and heart-related disease are leading causes of death in Ireland

Causes of death in Ireland 2018:

• Cancer: 31%
• Diseases of the circulatory system: 29%
• Disease of the respiratory system: 13%
• Mental and behavioural disorders: 6%
• Diseases of the nervous system: 5%
• External injuries and poisoning: 4%
• Diseases of the digestive system: 4%
• Other causes: 8%

Findings from the study reveal that cancer and heart-related disease are the leading causes of death in Ireland. A small increase in cancer deaths and a slight decrease in deaths due to heart-related conditions between 2013 and 2018 saw cancer become the leading cause of death in Ireland.

In 2018, 31% of people died of cancer. Over three-quarters of those deaths were caused by four types of cancer: gastrointestinal (31%), respiratory and thoracic (20%), breast and gynaecological (14%), and genitourinary and testicular (12%). Most cancer deaths occurred in people aged 65 years and older.

Heart-related conditions were the second most common cause of death in 2018, accounting for 29% of deaths. Diseases of the respiratory system were the third most common cause of death (13%).

Deaths caused by mental and behavioural disorders were found to have increased between 2013 and 2018. This change reflects increasing deaths due to dementia over that time.

The authors note that data on cause of death is based on what is recorded as the primary cause of death on death certificates. In the report, they highlight that this presents a limited picture of causes of death in Ireland, which, for many people, involve co-existing conditions rather than a single illness or condition.

The report calls for more detailed data to be made available to get a clearer understanding of the cause of death in Ireland.

Hospitals the most common place of death

Place of death 2018:
• Hospitals: 44%
• Home: 23%
• Long-stay residential care: 23%
• Specialist inpatient palliative care (Hospice): 8%
• Elsewhere: 3%

Hospitals are the most common place where people die in Ireland. The report found that over 2 in 5 (44%) people die in our hospitals each year. Home (23%) and long stay residential care (23%) are the second most common places in which Irish people die. The report also found that almost 1 in 10 people (8%) die in specialist inpatient palliative units (Hospices) each year. Many more patients are supported to die in their own homes by community specialist palliative care teams.

Commenting on the launch of the report, Peter May, Research Assistant Professor at Trinity College and study lead, said:

This report establishes what we know about how and where people die in Ireland, and there are some encouraging trends. Deaths from cardiovascular disease are falling thanks to long-run improvements in heart health. Deaths in hospital are relatively low compared to other countries, and access to specialist palliative care is relatively high.

At the same time, there are important issues to address. The number of deaths from dementia is rising rapidly. Data gaps on end-of-life experience limit our ability to plan and fund the required services. The number of people living and dying with incurable illness in Ireland will roughly double over the next 30 years. We must continue to reform our health service to meet the needs of this population, and improve our understanding of the care they need and want, if people at the end of life and their families are to get the support they need and deserve.

Welcoming the report, Sharon Foley, Chief Executive of Irish Hospice Foundation, said:

The findings from this report support much of what we have been saying in IHF for many years: that additional investment is needed in end-of-life care across all health, social and homecare settings. The fact that 2 in 5 people die in Irish hospitals each year highlights the importance of initiatives such as our Hospice Friendly Hospital programme, which works to ensure the principles of palliative care are embedded across the acute healthcare sector.

The report has also highlighted that some regions in Ireland do not have specialist inpatient palliative care units. Where a person lives should not be a barrier to access to the very best care at end-of-life, including access to specialist inpatient palliative care. We must do all we can to ensure equitable access to palliative and Hospice care in every region of Ireland. We are calling for urgent investment in home-based end-of-life care and in the development of specialist inpatient palliative care units in those regions that are currently without this vital service.

About the Dying and Death in Ireland Report
Dying and Death in Ireland: what do we routinely measure, how can we improve? contains findings from a Health Research Board grant-funded study, awarded to Dr. Peter May, Research Assistant Professor at Trinity College Dublin: the Palliative and End-of-Life Care data in Ireland: establishing the state of the nation, mapping future direction (PELCI) study. That study is using data from existing datasets in Ireland to answer questions about where people die, what health care they use, how family and friends provide unpaid care, and how palliative care shapes these experiences. The Dying and Death in Ireland report captures findings from the first phase of the PELCI study.