For the first time, countries around the world have an international classification specifically designed to describe the places where people are cared for at the end of life and die.
The United Nations Statistical Commission has adopted the International Classification of Dying Places (ICP), developed at the University of Coimbra through the European Research Council-funded EOLinPLACE Project. The ICP is now included in the United Nations Statistics Division's International Family of Statistical Classifications as an operational classification in the health domain, with the University of Coimbra as its custodian and coordinating entity.
Until now, there has been no international classification of dying places. Countries record place of death in different ways and use different categories and definitions, making it difficult to compare data internationally or obtain an accurate global picture of where people spend the final stages of life and where they die.
The ICP addresses this gap by providing a common international framework for classifying dying places. It is designed not only to describe the actual place of death, but also the places where people receive care at the end of life, where they would prefer to receive that care, and where they would prefer to die.
A core application identified by the United Nations is its use by medical doctors to record place of death on death certificates. The classification can also be applied in electronic death-registration systems, clinical records, surveys and research, providing countries with a standardised way to record and compare places of death, end-of-life care and preferences.
"We have international systems that allow countries to compare what people die from, but until now we have not had an international classification specifically dedicated to describing where people are cared for and where they die", says Barbara Gomes, who conceived the ICP and leads the EOLinPLACE Project at the Faculty of Medicine and the Centre for Innovative Biomedicine and Biotechnology (CiBB) of the University of Coimbra. "The ICP provides that common language."
"Establishing the international standard for dying places fills a significant gap in international official statistics and data. It supports the Sustainable Development Goals (SDGs), will inform policy and decision-making to better understand and support differing and distinct population groups, and enables more consistent and comparable mortality statistics", says Andrew Hancock, Chair of the United Nations Committee of Experts on International Statistical Classifications.
Why where people die matters
Place of death is routinely recorded in mortality statistics in many countries, but existing national classifications vary considerably. Categories such as "home", "hospital", "hospice", "nursing home" or "other" may be defined differently across health and social care systems. Even apparently straightforward comparisons between deaths at home and in hospital can therefore be difficult to interpret across countries.
The ICP introduces a standardised, hierarchical framework that can be used at different levels of detail, depending on the needs and data systems of each country.
At its broadest level, the classification distinguishes five major types of dying places: dwelling or domicile; health or care facility; other facility; vehicle; and outdoor. These are further divided into detailed categories and subcategories, allowing distinctions between settings such as a person's own residence and other types of dwelling; hospitals, long-term care facilities such as nursing homes, and independent hospice or palliative care facilities; ambulances and other vehicles; and different outdoor locations.
The classification also accommodates places that have often been difficult to represent adequately in conventional place-of-death categories, including collective dwellings such as shelters and prisons.
From place of death to the end-of-life pathway
A major innovation of the ICP is that it goes beyond simply identifying the location where death occurred.
The same classification can be used to describe different points in a person's end-of-life pathway: where care is received, where a person prefers to receive care, where they prefer to die, and where death ultimately occurs.
This creates the possibility of examining not only where deaths occur, but also how people move between places during the final stages of life and, when information on preferences is available, whether the places in which people are cared for and die correspond to what they wanted.
"With adequate support and care, it may be possible for a person with advanced illness to remain in the place they prefer, but these preferences are often conditional and may change according to the care a person needs and what is available," Gomes explains.
"Information about places of care and death, particularly when considered alongside people's preferences, can help us understand how well health and social care systems are responding to people at the end of life."
"For patients and people with lived experience, families and communities, where someone is cared for and where they die must reflect their preferences, needs and dignity. Until now, we have lacked the shared language to even see this clearly across countries, making it almost impossible to plan care that truly meets people where they are. The ICP marks a significant step towards health systems that are more equitable, accessible and responsive to the people they serve, particularly as the world prepares for ageing populations and the growing burden of non-communicable diseases", Dani Mothci, CEO of the International Alliance of Patients' Organizations (IAPO)
Built through international research, collaboration and consultation
The ICP was developed through EOLinPLACE – Choice of Where We Die: A Classification Reform to Discern Diversity in Individual End-of-Life Pathways, an international research project led by the University of Coimbra and funded by the European Research Council.
Its development draws on several years of research examining where people are cared for, where they prefer to receive care and where they ultimately die. Research was conducted across four contrasting countries — Portugal, the Netherlands, Uganda and the United States — through collaborations involving the NOVA National School of Public Health, Coimbra Health – Integrated Delivery System, Mulago National Referral Hospital, Leiden University Medical Center, Brown University and the University of Kansas Medical Center.
The development of the ICP incorporated contributions from more than 200 people, representing patients, informal carers, formal care providers, researchers, policymakers and statistical offices, with perspectives spanning all continents.
Patient and family perspectives were further strengthened through close collaboration with the International Alliance of Patients' Organizations (IAPO) and Eurocarers.
Throughout the project, an international Project Advisory Group provided independent interdisciplinary and stakeholder input. Chaired by Professor Irene Higginson of King's College London, the group brought together experts and representatives from Brown University, Vrije Universiteit Brussel, the University of Alberta, the International Children's Palliative Care Network, the European Association for Palliative Care, the International Association for Hospice and Palliative Care, IAPO, Eurocarers, the Organisation for Economic Co-operation and Development, the World Health Organization and the United Nations.
Together, these contributions helped ensure that the ICP was informed not only by research evidence, but also by the perspectives of the people, organisations and institutions that generate, use and are represented by data on dying places.
The result is a classification intended to be sufficiently standardised for international comparison while retaining enough detail to represent different health systems, populations and circumstances.
From an international standard to national implementation
Following its adoption by the United Nations Statistical Commission, the focus now turns to implementation.
A core application of the ICP is the recording of place of death by medical doctors on death certificates. Countries can use the ICP to harmonise existing place-of-death categories or incorporate its categories when mortality and civil registration systems, including electronic death-registration systems, are developed or revised.
The classification can also be used to record places of end-of-life care and preferred places of care and death, including through clinical records, population surveys and research.
Wider adoption would provide a common international metric for information already collected through many national mortality systems, while enabling substantially greater consistency and detail in how dying places are described. This would improve the ability to compare patterns between countries and over time.
Better data could support planning for palliative care, hospital and community services, long-term care and social support; help identify differences between populations and regions; and strengthen understanding of how patterns of care and death change during major health, social or humanitarian crises.
"Where people are cared for and where they die are fundamental indicators of how societies care for people towards the end of life," Gomes says. "For the first time, we now have an international framework through which countries can describe these places using a common language."
International Classification of Dying Places
- Decision of the United Nations Statistical Commission: https://unstats.un.org/UNSDWebsite/statcom/session_57/documents/2026-35-FinalReport-E.pdf decision 57/121b(v)
- Official United Nations classification entry: https://unstats.un.org/unsd/classifications/Family/Detail/2104
- International Classification of Dying Places (ICP), Version 1.0: https://estudogeral.uc.pt/bitstream/10316/121812/3/ICP_V1.0_2026.pdf
- United Nations report on the International Classification of Dying Places: https://unstats.un.org/UNSDWebsite/statcom/session_57/documents/BG-4e-5.2-ICP_Report-E.pdf
About Barbara Gomes
Barbara Gomes is Floriani Chair in Palliative Care at the Faculty of Medicine of the University of Coimbra and the Centre for Innovative Biomedicine and Biotechnology (CiBB). She is in the Stanford University/Elsevier Top 2% Scientists list (2025/2026).
With a background in Psychology and Health, she holds an MSc and PhD in Palliative Care from King's College London and has more than two decades of research experience in place of death and end-of-life care.
She leads the EOLinPLACE Project, supported by a European Research Council Starting Grant, and has authored more than 100 scientific publications, including work published in JAMA, Annals of Oncology and The BMJ.
About EOLinPLACE
EOLinPLACE – Choice of Where We Die: A Classification Reform to Discern Diversity in Individual End-of-Life Pathways is an international research project led by the University of Coimbra and funded by the European Research Council (ERC).
The project investigates where people are cared for and die, where they would prefer to be cared for and die, and how these experiences differ across countries and populations. A central objective of the project has been the development of the International Classification of Dying Places to improve the quality and international comparability of information about places of care and death.
EOLinPLACE brings together research and clinical partners in Portugal, the Netherlands, Uganda and the United States, alongside international patient, caregiver, professional, policy and statistical organisations.
More information: www.eolinplace.com
