Changing mortality and place of death in response to refugee influx: a population-based cross-sectional study in Jordan, 2005-2016

Ping Guo, Emeka Chukwusa, Majed Asad, Omar Nimri, Kamal Arqoub, Sawsan Alajarmeh, Asem Mansour, Richard Sullivan, Omar Shamieh, Richard Harding

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Background: Jordan faces complex healthcare challenges due to refugee influx and an ageing population. Palliative care planning and delivery require data to ensure services respond to changing population needs.

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

Design: Population-based study.Setting/subjects Death registry data of adult decedents (n=143,215), 2005-2016.

Measurements: Descriptive statistics examined change in demographic and place of death (categorised as hospital and non-hospital). Binomial logistic regression compared the association between hospital deaths and demographic characteristics in 2008-2010, 2011-2013, 2014-2016, with 2005-2007.

Results: The annual number of deaths increased from 6,792 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 non-ischaemic heart disease (OR: 1·11, 95% 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), haemorrhagic 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 amongst non-Jordanians in 2014-2016 for the following conditions: malignant neoplasms (except leukaemia), non-ischaemic heart disease, atherosclerosis, injury, and HIV, compared with 2005-2007.

Conclusions: Country-level palliative care development must respond to both internal (ageing) 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 prioritised and expanded to care for the patients with non-ischaemic heart disease, atherosclerosis, renal failure, haemorrhagic fevers, and injury.
Original languageEnglish
Pages (from-to)1616-1625
JournalJournal of Palliative Medicine
Issue number11
Early online date7 Apr 2021
Publication statusE-pub ahead of print - 7 Apr 2021


  • Mortality
  • cause of death
  • epidemiology
  • palliative care
  • place of death
  • refugees


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