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Receiving the home care service offered by certified care workers prior to a patients’ death and the probability of a home death: observational research using an instrumental variable method from Japan
  1. Kazuhiro Abe1,
  2. Atsushi Miyawaki1,
  3. Yasuki Kobayashi1,
  4. Haruko Noguchi2,
  5. Hideto Takahashi3,
  6. Nanako Tamiya4
  1. 1Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
  2. 2Faculty of Political Science and Economics, Waseda University, Tokyo, Japan
  3. 3National Institute of Public Health, Wako, Japan
  4. 4Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
  1. Correspondence to Dr Kazuhiro Abe; kazuhiro.abe.1215{at}


Objectives To assess the association between receiving the certified care workers’ home care service, which is provided by non-medical professionals prior to a patients’ death and the probability of a home death.

Design Observational research using the full-time translated number of certified care workers providing home care service per member of the population aged 65 or above, during the year prior to patient’s death per municipality as an instrumental variable.

Setting The certified care workers’ home care service covered by the public long-term care insurance (LTCI) system in Japan.

Participants In total, 1 613 391 LTCI beneficiaries aged 65 or above who passed away, except by an external cause of death, between January 2010 and December 2013 were included in the analysis.

Primary outcome measures Death at home or death at other places, including hospitals, nursing homes and clinics with beds.

Results Out of all participants, 173 498 (10.8%) died at home. The number of patients who used the certified care workers’ home care service more than once per each month during 1, 2 or 3 months prior to the month of death numbered 213 848, 176 686 and 155 716, respectively. This was associated with an increased probability of death at home by 9.1% points (95% CI 2.9 to 15.3), 10.5% points (3.3 to 17.6) and 11.4% points (3.6 to 19.2), respectively.

Conclusions The use of the certified care workers’ home care service prior to death was associated with the increased probability of a home death.

  • home care services
  • place of death
  • long-term care insurance
  • palliative care
  • instrumental variable method
  • respite care

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  • Contributors KA conceived the study. KA and AM wrote the first and successive drafts of the manuscript. KA, AM, YK and HN contributed to study’s conception, design and modelling. KA and HN contributed to data management and analysis. HN, HT and NT collected the data. All authors revised the manuscript for important intellectual content. All authors had full access to the data and take responsibility for the integrity of the data and the accuracy of the data analysis. YK is the guarantor.

  • Funding This work was supported by the Japanese Ministry of Health, Labour and Welfare grant number H27-seisaku-senryaku-012, the Japan Society for the Promotion of Science grant number 18H03021 and the Japan Agency for Medical Research and Development grant number JP18dk0110026. The Japanese Ministry of Health, Labour and Welfare approved the secondary use of the data for this study (approval no. 1218-1).

  • Disclaimer The funders had no role in the design and conduct of the study; management, analysis and interpretation of the data and preparation, review or approval of this manuscript.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The Ethics Review Committees of the University of Tokyo (approval no. 11070-1) and the University of Tsukuba (approval no. 1009).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No additional data are available.

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