---
title: "End-of-life symptom prevalence and drivers among hospital decedents in South Korea"
id: "plos-one-3-prevalence-and-influencing-factors-of-end-of-life-symptoms-among-hospital"
canonical_url: "https://medichelpline.com/clinical-feed/plos-one-3-prevalence-and-influencing-factors-of-end-of-life-symptoms-among-hospital"
content_type: "clinical_feed_article"
specialty: "General"
source_name: "PLOS ONE (Medicine)"
source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041"
published_at: "2026-08-25T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# End-of-life symptom prevalence and drivers among hospital decedents in South Korea
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-one-3-prevalence-and-influencing-factors-of-end-of-life-symptoms-among-hospital
- **Specialty:** [General](https://medichelpline.com/clinical-feed/general.md)
- **Primary Source:** PLOS ONE (Medicine)
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041)
- **Published At:** 2026-08-25T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- This cross-sectional secondary analysis used proxy exit-interview data from the Korean Longitudinal Study of Aging (KLoSA) covering deaths between 2006 and 2020, focusing on adults aged ≥45 who died in hospital (n = 1,731). - Mean age at death was 74.2 years; 52.9% were male. Decedents had on average four chronic conditions; hypertension (52.9%), cancer (45.6%), and diabetes (41.6%) were most common. - Eleven proxy-reported symptoms in the last month of life were assessed and dichotomized; “don’t know” responses were recoded as absent. - The mean symptom count was 4.76. The most prevalent symptoms were **loss of appetite** (66.5%), **severe fatigue** (59.4%), and **depression** (54.3%). - Key factors consistently associated with symptom occurrence across most symptoms were **prolonged illness duration**, greater dependency in **ADLs and IADLs**, and prior **pain** in the year before death. - Only 4.51% of decedents had recorded hospice admission before death, indicating limited access to formal palliative services among this inpatient population. - Statistical methods used survey-weighted analyses: descriptive statistics, survey-weighted linear and negative binomial regression for symptom counts, and 11 multivariable logistic regression models (one per symptom) with complex sampling weights and VIF checks for multicollinearity. - The authors conclude there is a high end-of-life symptom burden among hospital decedents in South Korea and recommend earlier recognition of symptom indicators, integration of palliative care into hospital practice, and expanded hospice access to improve quality of dying. - Data source, survey design, inclusion/exclusion criteria, and measurement instruments were clearly described; proxy reporting and recoding rules (treating “don’t know” as no) were explicitly reported and acknowledged as a limitation for possible recall bias.
## Clinical Analysis & Structured Key Points
[ Skip to main content ](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#main-content) Advertisement * [plos.org](https://plos.org/) * [Create account](https://community.plos.org/registration/new) * [Sign in](https://journals.plos.org/user/secure/login?page=%2Fplosone%2Farticle%3Fid%3D10.1371%2Fjournal.pone.0357041) * * About * Browse * Publish * [](https://journals.plos.org/plosone/ "PLOS One") * Search [advanced search](https://journals.plos.org/plosone/search) * [Browse Topics](https://journals.plos.org/plosone/subjectAreaBrowse) Browse Subject Areas ? Click through the PLOS taxonomy to find articles in your field. For more information about PLOS Subject Areas, click [here](https://github.com/PLOS/plos-thesaurus/blob/master/README.md "Link opens in new window"). [](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041) [](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041) * 0 [Save](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0357041#savedHeader) [Total Mendeley and Citeulike bookmarks.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0357041#savedHeader) * 0 [Citation](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0357041#citedHeader) [Paper's citation count computed by Dimensions.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0357041#citedHeader) * 17 [View](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0357041#viewedHeader) [PLOS views and downloads.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0357041#viewedHeader) * 0 [Share](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0357041#discussedHeader) [Sum of Facebook, Twitter, Reddit and Wikipedia activity.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0357041#discussedHeader) Open Access Peer-reviewed Research Article # Prevalence and influencing factors of end-of-life symptoms among hospital decedents in South Korea: A cross-sectional secondary analysis * Jooyoung Cheon, Roles Conceptualization, Formal analysis, Funding acquisition, Investigation, Methodology, Validation, Writing – original draft, Writing – review & editing Affiliation Department of Nursing Science, Sungshin Women’s University, Seoul, Republic of Korea [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0001-9622-0937 ](https://orcid.org/0000-0001-9622-0937 "ORCID Registry") ⨯ * Eun Young Choi Roles Conceptualization, Formal analysis, Methodology, Validation, Visualization, Writing – original draft, Writing – review & editing * E-mail: eychoi@cau.ac.kr Affiliation Department of Nursing, Chung-Ang University, Seoul, Republic of Korea [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0003-0602-2019 ](https://orcid.org/0000-0003-0602-2019 "ORCID Registry") ⨯ # Prevalence and influencing factors of end-of-life symptoms among hospital decedents in South Korea: A cross-sectional secondary analysis * Jooyoung Cheon, * Eun Young Choi ![PLOS](https://journals.plos.org/resource/img/logo-plos-full-color.svg) x * Published: August 25, 2026 * * [Article](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041) * [Authors](https://journals.plos.org/plosone/article/authors?id=10.1371/journal.pone.0357041) * [Metrics](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0357041) * [Comments](https://journals.plos.org/plosone/article/comments?id=10.1371/journal.pone.0357041) * [Media Coverage](http://plos.altmetric.com/details/doi/10.1371/journal.pone.0357041) * [Peer Review](https://journals.plos.org/plosone/article/peerReview?id=10.1371/journal.pone.0357041) * [Abstract](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#abstract0) * [Introduction](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#sec005) * [Materials and methods](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#sec006) * [Results](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#sec014) * [Discussion](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#sec018) * [Conclusion](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#sec021) * [Supporting information](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#sec022) * [References](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#references) * [Reader Comments](https://journals.plos.org/plosone/article/comments?id=10.1371/journal.pone.0357041) * [Figures](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041) ## Abstract ### Background South Korea has the highest proportion of in-hospital deaths among OECD countries, yet population-based data on end-of-life symptom burden among hospital decedents remain scarce. This study examined end-of-life symptom prevalence in the last month of life and factors associated with each symptom among hospital decedents in South Korea. ### Methods This cross-sectional secondary analysis used exit interview data from the Korean Longitudinal Study of Aging spanning 2006–2020. A total of 1,731 adults aged ≥45 years who died in hospital were included. Eleven proxy-reported symptoms were examined. Multivariable logistic regression with complex survey weights was used to identify factors associated with each symptom. ### Results The mean age at death was 74.2 years (range: 47–103), and the mean symptom count was 4.76. The most prevalent symptoms were loss of appetite (66.5%), severe fatigue (59.4%), and depression (54.3%). Prolonged illness duration, functional dependence in ADL and IADL, and pain experience in the year before death were the factors most consistently associated with symptom occurrence across nearly all symptoms. ### Conclusion These findings indicate that end-of-life symptom burden among hospitalized decedents in South Korea is high and consistently associated with prolonged illness duration, functional dependence, and pain. With only 4.51% of decedents having accessed hospice care before death, a critical gap exists between symptom burden and available palliative support. Early recognition of symptom indicators, integration of palliative care into hospital practice, and expanded access to hospice services are essential to improving the quality of dying. ## Figures ![Fig 3](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0357041.g003) ![Table 2](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0357041.t002) ![Fig 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0357041.g001) ![Table 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0357041.t001) ![Fig 2](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0357041.g002) ![Fig 3](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0357041.g003) ![Table 2](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0357041.t002) ![Fig 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0357041.g001) ![Table 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0357041.t001) ![Fig 2](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0357041.g002) **Citation:** Cheon J, Choi EY (2026) Prevalence and influencing factors of end-of-life symptoms among hospital decedents in South Korea: A cross-sectional secondary analysis. PLoS One 21(8): e0357041. https://doi.org/10.1371/journal.pone.0357041 **Editor:** Francesco Curcio, University of Naples Federico II, ITALY **Received:** February 2, 2026; **Accepted:** August 11, 2026; **Published:** August 25, 2026 **Copyright:** © 2026 Cheon, Choi. This is an open access article distributed under the terms of the [Creative Commons Attribution License](http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. **Data Availability:** The dataset generated and analysed during the current study is publicly available from the Korea Longitudinal Study of Aging (KLoSA), provided by the Korea Employment Information Service (KEIS), and can be accessed through the official English data board at . **Funding:** This work was supported by the Sungshin Women’s University Research Grant of 2023, awarded to JC ([https://www.sungshin.ac.kr)](https://www.sungshin.ac.kr). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. **Competing interests:** The authors have declared that no competing interests exist. ## Introduction As life expectancy increases and more people live with cancer and chronic illnesses, there is a growing societal demand for a dignified death or quality end-of-life care for older adults [[1](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref001)–[3](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref003)]. While many individuals express a preference to die at home [[4](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref004),[5](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref005)], a significant proportion still pass away in healthcare facilities in South Korea [[2](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref002)]. The Organization for Economic Co-operation and Development (OECD) uses the proportion of deaths occurring in healthcare facilities as an indirect measure of the quality of end-of-life care [[1](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref001)]. South Korea recorded the highest rate, with 69.9% of deaths occurring in healthcare facilities, which is substantially higher than the 49.1% average across 36 OECD member countries during the same period [[1](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref001)]. By 2025, this rate had risen further to 75.7% [[2](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref002)]. This high proportion of in-hospital deaths is largely attributed to a lack of sufficient palliative care options outside of hospital settings and the expectation that hospitals can better manage uncontrolled symptoms associated with terminal illness [[1](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref001),[3](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref003),[6](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref006),[7](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref007)]. For hospitalized patients at the end-of-life, effective symptom management is a top priority, as symptoms—reflecting changes in physical, psychosocial, sensory, or cognitive functioning—profoundly affect the ability to die with dignity and comfort [[3](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref003),[8](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref008),[9](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref009)]. Many of these symptoms are not adequately recognized or treated in the last months of life and tend to worsen as death approaches [[10](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref010)–[13](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref013)]. Inadequate symptom management can lead to functional decline, increased caregiver burden, and greater utilization of healthcare resources, such as higher rates of hospitalizations, readmissions, and emergency care [[7](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref007),[8](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref008),[10](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref010),[11](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref011)]. Consequently, healthcare providers must be proficient in end-of-life symptom management and should take proactive steps to prevent and address common and frequent symptoms whenever possible [[14](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref014)]. Previous studies of end-of-life patients have shown that symptom burden increases significantly during the last months of life, influenced by demographic, socioeconomic, and disease-related factors [[7](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref007),[8](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref008),[10](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref010),[12](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref012),[13](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref013),[15](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref015)–[17](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref017)]. Common symptoms experienced by these patients include pain, shortness of breath, fecal and urinary incontinence, sleep difficulties, loss of appetite, issues with nutrition/hydration, fatigue, lack of energy, drowsiness, delirium (or agitation), anxiety, and depression [[7](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref007),[8](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref008),[10](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref010),[13](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref013),[17](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref017)]. Factors influencing the frequency or severity of end-of-life symptoms include age, sex, socioeconomic status, employment, smoking habits, family support, type of illness, whether the patient is receiving active chemotherapy (for cancer patients), and impairments in activities of daily living (ADLs) and instrumental activities of daily living (IADLs) [[12](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref012),[13](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref013),[15](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref015),[16](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref016)]. However, these factors vary depending on the type of symptom [[15](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref015),[16](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref016)]. In South Korea, no studies have yet examined the prevalence of symptoms and the factors associated with each symptom among end-of-life patients who died in hospitals. The present study utilized data from the Korean Longitudinal Study of Aging (KLoSA), a nationwide panel survey that follows community-dwelling adults aged 45 and older across their entire life course—from middle age through death [[18](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref018)]. Uniquely among Korean panel surveys, KLoSA conducts post-mortem exit interviews with proxies (e.g., family members or close acquaintances) once a participant’s death is confirmed, enabling the collection of end-of-life data that would otherwise be inaccessible [[18](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref018)]. This approach is methodologically consistent with internationally recognized longitudinal aging studies, such as the U.S. Health and Retirement Study (HRS) [[19](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref019)] and the English Longitudinal Study of Ageing (ELSA) [[20](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref020)], which similarly employ proxy-reported post-mortem interviews to capture end-of-life experiences. Although proxy-reported data carry an inherent risk of recall bias, they remain an important and widely accepted source of information on the circumstances surrounding death, particularly when patient self-report is no longer possible [[21](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref021),[22](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref022)]. Recognizing the need for research in this area is critical, as understanding the specific symptoms experienced in the last months of life can improve the quality of end-of-life care [[10](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref010)]. Identifying the prevalence and influencing factors of these symptoms is essential for assessing their burden and providing insights to healthcare providers and policy makers on enhancing end-of-life care. This study aimed to (1) determine the prevalence of end-of-life symptoms experienced in the last month of life among hospital decedents in South Korea, and (2) identify demographic, clinical, and care-related factors associated with these symptoms. ## Materials and methods ### Design This study is a cross-sectional secondary analysis of data from the Korean Longitudinal Study of Aging (KLoSA), conducted by the Korea Labor Institute and the Korea Employment Information Service [[18](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref018)]. ### Data source and participants The KLoSA is an ongoing, nationwide longitudinal panel survey in South Korea that targets community-dwelling individuals aged 45 years and older. Participants are randomly selected using a multistage, stratified sampling method that accounts for housing type and geographic region, ensuring representation of the entire population of South Korea. Data collection occurs biennially through interviews, covering household background, socioeconomic status, and psychological and health-related characteristics. The initial panel sample in 2006 comprised 10,254 middle-aged and older adults (born in 1961 or earlier). Survey retention rates were as follows: 86.6% in 2008, 81.7% in 2010, 80.1% in 2012, 80.4% in 2014, 79.6% in 2016, 78.8% in 2018, and 78.1% in 2020 [[18](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357041#pone.0357041.ref018)]. Between 2008 and 2020, a total of 3,545 deaths were recorded among panel participants across the seven biennial survey waves. Exit interviews were conducted only
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