Estimating palliative care demand at the end of life in Peru: A mortality-based analysis of 1,133,608 deaths (2017–2024)

Objective To analyze the need for PC in Peru between 2017 and 2024. Study design Cross-sectional analytical study based on routinely collected mortality data. Methods We analyzed all deaths recorded in Peru's National Death Information System (SINADEF) between January 1, 2017 and April 2024, excluding records with missing sex, age, or place of death. PC need was estimated using The Lancet Commission method (20 conditions generating serious health-related suffering and condition-specific weights). Associated factors were assessed using Poisson regression with robust variance to estimate prevalence ratios (PR) and 95% confidence intervals (95% CI); a 10% effect-size threshold (PR ≥ 1.10 or ≤ 0.90) defined clinical relevance. Results A total of 1,093,463 deaths were analyzed, of which 66.1% would have required PC. The departments with the highest need were Huancavelica (77.9%), Apurímac (77.0%), and San Martín (74.3%). Factors associated with a greater need for palliative care include affiliation with a type of health insurance, residence in the highlands (Sierra) region, the periods during and after the pandemic, and death in a healthcare facility. Regarding the ethnicity variable, a lower reported need was observed among Andean indigenous people and those without ethnic classification, compared to Mestizo individuals. Conclusions A considerable proportion of deaths in Peru likely required palliative care, with marked geographical and sociodemographic inequalities. This underscores the urgency of strengthening and decentralizing PC services, integrating them equitably into the health system.