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

Research output: Contribution to journalArticlepeer-review


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

Colleges, School and Institutes

External organisations

  • King's College London
  • Ministry of Health, Jordan
  • King Hussein Cancer Center


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
JournalJournal of Palliative Medicine
Publication statusE-pub ahead of print - 7 Apr 2021


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