2. Deaths in hospitals, in institutions, at home

DATA COLLECTION BY PLACE OF DEATH. The share of deaths occurring in hospital, at home and in institutions for the elderly varies from country to country, depending on the national organization of care and patterns of residence. Deaths occur in hospital, at home or in institutions [1]: for example, in France, just over a quarter of all deaths in a year usually occur at home, 60% in hospitals and 14% in institutions for the elderly. The information system for counting deaths may vary according to these places of death.

Some counts are not immediately available. In France, since 2015, it has only been possible to count deaths in hospital on a daily basis. At the beginning of the epidemic and until 5 April, the daily accumulation of deaths by COVID-19 only concerned deaths in hospital. It should be noted that a portion of the residents of the institutions died in hospital; these hospital deaths were therefore counted. Next, a system was put in place to obtain the daily institutional mortality (initially partial information).Deaths at home are not yet included in the total count in France.


It is now possible:

  1. to better estimate the number of deaths by COVID-19
  2. to distinguish among the hospital deaths, those related to people living or not in institutions an.

1. The correction in France with the announcement of deaths in institutions
significantly increases the impact of the epidemic in terms of deaths, adding almost 7 900 deaths in institutions to the 12 900 cumulative hospital deaths as of 21 April and bringing the French situation closer to those of Spain and Italy. However, the dynamics seem similar, with a plateau in the daily number of deaths in institutions and hospitals during April, with the exception of fluctuations probably linked to the catch-up in reporting deaths after weekends and public holiday (ie. Easter Monday 13/04), especially those occured in institutions.

Figure 2.1. Numbers and daily totals of deaths in hospitals and in institutions by COVID-19 in France.

Data and metadata. Source : SpF


2. As of April 15, 61% of COVID-19 deaths occurred in hospitals and 39% in social and medical institutions [2].

Adding the share of deaths in institutions and hospital deaths that concern residents of institutions, a total of 51% of COVID-19 deaths concerned residents of the institutions (39% occurred in the institution and 12% in hospital). It is therefore crucial to be able to better qualify mortality in institutions, particularly those hosting the elderly.

COVERAGE OF THE COLLECTED DATA? Beyond the question of the place of death in institutions, hospitals and homes, there is the question of coverage for death notifications in each of these places. This is due to the data collection systems used for a rapid feedback of information. Sometimes it is the electronic registration systems that feed national data almost in real time: but does this type of system cover all structures, regardless of their size, geographical location, private or public nature? 

At this stage, it is difficult to know whether the figures announced in the various countries are exhaustive, partial, representative or not of deaths by COVID-19.

In France, hospital deaths counts are exhaustive, deaths counts in institutions correspond to the deaths notified in the dedicated plateform, less immediate. In Spain, the stratification of deaths due to COVID-19 by age and sex is partial at the moment: as of April 23, this detailed information is only available for 13,105 deaths out of a total of 22,524 deaths (MSCBS) [3]. In Italy and Germany, the published statistics cover, in principle, all places of death; the degree of completeness of reporting is not specified. During the course of the pandemic, various systems are implemented in order to complete the daily reports as much as possible.

  Figure 2.2. Total COVID-19 deaths in hospitals and in institutions, in the population living in and outside institutions.

Data and metadata. Source : SpF