Abstract
INTRODUCTION: The place of death is recognized as a proxy for the quality and equity of end-of-life care. Understanding where people die provides insights into health system performance, social inequalities, and the availability of palliative services. In Peru, evidence on this topic remains scarce, and national patterns and determinants have not been previously characterized. METHODS: We conducted a cross-sectional analytical study including all deaths registered in SINADEF from January 2017 to April 2024. Deaths were categorized as occurring at home, in a healthcare facility, or elsewhere. Sociodemographic, geographic, and contextual variables were analyzed, and the need for palliative care was estimated using the methodology of The Lancet Commission on Global Access to Palliative Care and Pain Relief. Associations were assessed using Poisson regression models with robust variance to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (CIs). RESULTS: A total of 1,093,463 deaths were analyzed. Overall, 53.1% occurred in healthcare facilities, 41.3% at home, and 5.6% elsewhere. The proportion of home deaths increased over the study period (p < 0.001). Older age, lack of health insurance, lower educational level, lower socioeconomic status, Indigenous ethnicity, and residence outside Metropolitan Lima were associated with higher prevalence of home death. In contrast, individuals with estimated palliative care needs were less likely to die at home (aPR = 0.66; 95% CI: 0.65 to 0.66). Marked regional heterogeneity was observed, with home deaths ranging from 23.5% in Madre de Dios to 62.3% in Puno. CONCLUSIONS: More than four in ten deaths in Peru occur at home, with increasing trends over time and wide regional and social disparities. The findings suggest that dying at home often reflects structural inequities and limited access to institutional or palliative care rather than preference. Strengthening community- and home-based palliative services is crucial to ensure that end-of-life care aligns with patients’ needs and values. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13690-026-01872-9.