(2024) 22:350
Leniz et al. BMC Medicine
https://doi.org/10.1186/s12916-024-03570-1

BMC Medicine

RESEARCH ARTICLE

Open Access

Past trends and future projectionsof palliative care needs in Chile: analysisof routinely available death registry
and population data
Javiera Leniz1,2* , Angélica Domínguez1, Anna E. Bone2, Simon Etkind3,4, Pedro E. Perez‑Cruz5 andKatherine E. Sleeman2

Abstract
Background The number of people with palliative care needs is projected to increase globally. Chile has recently
introduced legislation for universal access to palliative care services for patients with severe and terminal illnesses,
including non-cancer conditions. We aimed to estimate the number of people affected by serious health-related suf‑
fering and need for palliative care in Chile to 2050.
Methods We used data on all deaths registered in Chile between 1997-2019 and population estimates for 1997–
2050. We used Poisson regression to model past trends in causes of death adjusted by age, sex and population
estimates, to project the number of deaths for each cause from 2021 to 2050. We applied the Lancet Commission
on Palliative Care and Pain Relief weights to these projections to identify decedents and non-decedents with palliative
care needs.
Results Population palliative care needs in Chile are projected to increase from 117 (95% CI 114 to 120) thousandpeople in 2021 to 209 (95% CI 198 to 223) thousand people in 2050, a 79% increase (IRR 1.79; 95% CI 1.78–1.80). This
increase will be driven by non-cancer conditions, particularly dementia (IRR 2.9, 95% CI 2.85–2.95) and cardiovascularconditions (IRR 1.86, 95% CI 1.83–1.89). By 2050, 50% of those estimated to need palliative care will be non-decedents(not expected to die within a year).
Conclusions Chile will experience a large increase in palliative care needs, particularly for people with dementia
and other non-cancer conditions. Improved availability of high-quality services, expanded clinician training and newsustainable models of care are urgently required to ensure universal access to palliative care.
Key messages• Estimating the number of people who experience serious health-related suffering and might benefit from palliative
care need is key for service planning. This is particularly relevant in Chile, where a new law has been implemented
that guarantees access to palliative care services for all patients with terminal conditions and severe diseases.
*Correspondence:
Javiera Leniz
jleniz@uc.cl
Full list of author information is available at the end of the article© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which
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Leniz et al. BMC Medicine(2024) 22:350

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• We estimated the number of people who will experience serious health-related suffering and palliative careneeds in Chile by 2050.
• The number of people with palliative care needs in Chile is going to almost double by 2050, mainly due
to an increase in the number of people living and dying with dementia and non-cancer conditions.
• The projected increase in the number of people with palliative care needs highlights the need for enhancing
availability of services, increase personnel training and new sustainable models of care, in particular for non-can‑cer conditions.
Keywords Palliative care needs, Projections, Population estimations, Serious health-related suffering

Background
Globally, it is estimated that around 25 million people
die every year with serious health-related suffering. This
global burden is projected to almost double by 2060, withthe greatest increase in low- and middle-income countries [1]. Most of this increase is driven by increases in
the number of people dying from cancer, cardiovasculardisease and dementia [1]. People living with serious illnesses can experience physical and psychological symptoms that have an impact not only on the patient but also
on caregivers and society [2–5]. There is evidence pointing towards cost-effectiveness of some palliative care service models [6], and palliative care has been included asa key aspect of Universal Healthcare Access [7]. Given
the projected increase in serious health-related suffering,
universal access to palliative care services has become apublic health priority.
According to the Global Atlas of Palliative Care, mostcountries in Latin America are in an early stage of palliative care service development, with low access topalliative care services [8]. Chile implemented a pain
management program for cancer patients in 1995, which
was later enhanced by a more comprehensive palliative care service for people with advanced cancer underthe Health Explicit Guarantee’s Law in 2004 [9]. These
schemes have contributed to an increase in access toopioids and palliative care services for people with cancer in Chile [10]. In 2019, around 44,000 cancer patients
accessed palliative care services, representing 93% of thetotal number of cancer patients in need of palliative care[11], but only 42% of patients (including both patientswith cancer and non-cancer conditions) in need of palliative care accessed palliative care services [11]. Regardlessof this gap in access, Chile was ranked among the countries with the best access to palliative care in Latin America [10], and 27th in the 2015 Quality of Death Global
Index [12].
In 2022, a new law that guarantees access to palliative
care services for all patients with terminal conditions
and severe diseases was introduced in Chile [13], enforcing the need to expand services to provide palliative careaccess to all those who need it. Two studies have investigated the demand for palliative care services in Chile
between 2018 and 2020 [11, 13]. Using the Lancet Commission method to estimate population palliative careneeds, Perez-Cruz et al. estimated that 104,923 patientswould have benefited from palliative care in 2019 inChile. Fifty-six percent of them were affected by noncancer conditions and only 51% were in the last year oflife [11]. Using different methodologies, Armijo et al.
estimated that between 2018 and 2020, 21,679–25,650
people with non-cancer conditions needed palliative
care in the last year of life each year [13].
While access to palliative care services among cancer
patients in Chile is relatively high, this does not necessarily imply high-quality care or a regular provision ofservices. To support effective healthcare planning, it isnecessary to understand both current and future needs.
We aimed to estimate the number of people affected byserious health-related suffering and need for palliative
care in Chile by 2050, to support a planned increase inhigh-quality palliative care services.

Methods
DesignSecondary analysis of routinely available national deathregistry and population estimates data provided by
the Department of Health Information and Statistics(DEIS) and the Institute for National Statistics (INE)in Chile respectively. We used death registry data andpopulation estimates to identify past trends in thenumber of deaths by cause of death and then to derive
future trends. We used population estimates to accountfor the demographic structure of the population.
Data sources
Death registry data

Death registry data in Chile is collected, verified andpublished jointly by the INE, Civil Register Office andthe DEIS [14]. Certification of death by a physician is
mandated by law and the coverage and quality of deathcertificates have been judged as high [14, 15]. DeathLeniz et al. BMC Medicine(2024) 22:350

certificates use the standard World Health Organization
International form which records the sequence of diseases that led directly to death and all other contributing
causes of death [16]. Based on the information recordedon death certificates, trained staff from the DEIS manually select and code the underlying cause of death basedon the International Statistical Classification of Diseases
and Related Health Problems 10th revision (ICD-10)
guidelines [17, 18]. A death registry dataset that contains
all deaths registered in the country between 1990 and
2020, except external causes of death, is publicly available
from the DEIS website [19]. We extracted individual-level
information on age, sex, year of death and underlying
cause of death for all deaths registered in Chile between
1997 and 2019 from that dataset [19]. Pre-1997 deaths
were excluded due to changes in how cause of death wascoded. We excluded deaths during 2020 because temporary changes in cause of deaths from the COVID-19 pandemic would have skewed the projection model.
Population estimates

Population estimates in Chile are regularly producedby the INE. These estimates contain information on the
population size and demographic structure by year andare based on information from the last census and a setof assumptions on fertility, mortality and internationalmigration trends [20]. A dataset with these population
estimates is available from the INE website [20]. We
extracted information on the estimated population in
Chile between 1997 and 2050, stratified by age and sex
from the most recent population estimation and projections for Chile, which was based on the 2017 census [20].
Palliative care needs estimations

To estimate the number of people who might need palliative care, we used the method developed by the Lancet Commission on Global Access to Palliative Careand Pain Relief [21]. We used this approach as it has
been used in previous research exploring palliative careneeds in Chile and elsewhere [1, 11, 21]. Based on expert
opinion, the Lancet Commission identified a set of 20
conditions that most commonly result in death or in
suffering that is severe enough to benefit from palliative
care, including conditions that affect children [21]. Estimates of palliative care needs are then derived based on
the number of people who die from these 20 conditions,separately for decedents and non-decedents. The Lancet
Commission provided methods to estimate the proportion of decedents with each condition who need palliative care during their last year of life, based on symptom
prevalence. In addition, because palliative care might be
expected to benefit people with some conditions before
their last year of life, the Lancet Commission provided

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methods to estimate the number of non-decedents whoneed palliative care for 11 relevant conditions (expressed
relative to the number of decedents for each condition in
the population). Table 1 shows the 20 conditions identified by the Lancet Commission and the ICD-10 related
codes we used. Originally, the Lancet Commission codesfor dementia only included ICD-10 codes F00–F04, while
ICD-10 codes “G30: Alzheimer disease” and “G31.1:
Senile degeneration of brain” which are commonly used
to identify people who died from dementia [22–24] were
included in the section “Central nervous system (CNS)
non-inflammatory conditions”. As G30 and G31 codes arecommonly used in Chile to report dementia deaths, weused them to identify dementia deaths rather than other
CNS degenerative conditions [22–24]. We calculated theannual number of decedents (for the 20 conditions) andnon-decedents (for the 11 conditions) between 1997 and2019 and applied the weights defined by the Lancet Commission to estimate the number of decedents and nondecedents with palliative care needs (1997–2019) [21].
Death projections

To project palliative care needs, first we calculated thenumber of deaths for each of the 20 conditions likely tocause serious health-related suffering and need for palliative care, by category of age (by 5-year intervals), sex(male, female) and year of death (1997–2019). As 2020
was an anomalous year, with an unusually high numberof deaths caused by COVID–19 infection, we did notinclude deaths in 2020. As the number of deaths by year
was highly variable for less prevalent conditions, we useda simple moving average data smoothing approach, calculating the average of the number of deaths from previous, current and following year for each condition. For
deaths in 1997 and 2019, a two-point average (current
and nearest year) was used [25].
We used Poisson regression models to calculate theestimated number of deaths for each of the 20 conditions by year (1997–2019), adjusted by age, sex and theexposed population. These models allowed us to estimate
past trends and to then predict the age and sex adjusted
number of deaths (with 95% confidence intervals (CI))
for 2020–2050 using the forecast function in Stata andbased on the INE population projections.
Finally, we applied the weights from the Lancet Commission method to the estimated past deaths and projected
deaths for each of the 20 conditions, adjusted by age andsex, to estimate the number of decedents and non-decedents likely to have serious health-related suffering andneed for palliative care from 2020 to 2050. The 20 conditions were grouped into cancer, cardiovascular diseases,
chronic organ failure, non-communicable diseases, dementia and other conditions (Table 1). More information on theLeniz et al. BMC Medicine(2024) 22:350

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Table 1 The 20 conditions most likely to cause serious health-related suffering that requires palliative care, as identified in the Lancet
Commission on Global Access to Palliative Care and Pain Relief, and the ICD-10 codes used [21]Condition category
CancerConditions

ICD-10 code

Malignant neoplasm, excluding leukaemia*

C00–C97 (except C91–C95)

Leukaemia

C91–C95

Cerebrovascular disease*

I60–I69

Heart rheumatic disease, cardiomyopathies and heart failure

I05–I09, I10–I15, I42, I50

Ischemic heart disease

I25

Chronic lung disease

J40–47, J60–70, J80–84, J95–99

Liver disease

K70–K77

Chronic renal kidney

N17–N19

Musculoskeletal diseases*

M00–M97

Atherosclerosis (not included in other categories)

I70

Haemorrhagic fevers*

B33.4

TB*

A15–A19HIV*

B20–B24

CNS inflammatory conditions*

G00–G09

Dementia

Dementia*

F00–F04, G30–G32

Other

CNS non-inflammatory conditions*

G20–G26, G35–G37, G40–G41, G80–83

Preterm birth complications and birth trauma

P07, P10–P15

Congenital malformations*

Q00–Q99

Wounds, intoxications, external causes*

S00–S99, T00–T98, V01–Y98

Malnutrition

E40–E46

Cardiovascular diseases

Chronic organ failure

Communicable diseases*Conditions where palliative care needs were estimated for decedents and non-decedents
CNS Central Nervous System, TB Tuberculosis, HIV Human Immunodeficiency Virus

weights used is available in Additional file 1: Table S1. Moredetail in the methods followed is available in Additional
file 2. The Stata® 17.0 software was used for the analysis.

Results
Between 1997 and 2019, the annual number of deaths
in Chile rose from 78,472 to 109,658, with a mortality
rate from 5.3 to 5.7 per 1000 people. In 1997, based on
the Lancet Commission weightings, 34,957 (44.5%) of
the 78,472 observed deaths were from conditions likely
to require palliative care. This proportion increased to
52,645 (48.0%) in 2019 (Additional file 1: Table S2).
The number of decedents with palliative care needs
is estimated to increase from 57,596 (95% CI 56,325 to

58,953) in 2021 to 104,809 (95% CI 99,746 to 111,612) in
2050 (Table 2 and Additional file 1: Table S3). This represents an 82% increase in the number of decedents withpalliative care needs (incidence risk ratio (IRR) 1.82, 95%
CI 1.80 to 1.84) between 2021 and 2050. The number ofpeople with palliative care needs who are not expected todie within a year (non-decedents) is expected to increase
from 58,869 (95% CI 57,244 to 60,634) in 2021 to 103,688(95% CI 97,907 to 111,379) in 2050 representing a 76%
increase (IRR 1.76; 95% CI 1.74–1.78). Overall, the number of people with palliative care needs who are notexpected to die within a year represents 50% of the total
number of people with palliative care needs (Table 2 andAdditional file 1: Table S3).

Table 2 Estimated number of decedents and non-decedents with palliative care needs in Chile in 2021 and 2050
2021

2050

n (95% IC)

n (95% IC)

IRR (95% CI)

Decedents

57,595.8 (56,324.5–58,952.5)

104,808.5 (99,746.1–111,611.5)

1.82 (1.80–1.84)

Non-decedents

58,868.6 (57,243.6–60,634.0)

103,687.9 (97,907.1–111,378.6)

1.76 (1.74–1.78)

Total

116,464.4 (113,568.1–119,586.5)

208,496.4 (197,653.1–222,990.1)

1.79 (1.78–1.80)

Leniz et al. BMC Medicine(2024) 22:350

Including the number of people who might benefit
from palliative care before the last year of life (non-decedents), the total estimated number of people with palliative care needs is projected to increase from 116,464(95% CI 113,568 to 119,587) in 2021 to 208,496 (95% CI
197,653 to 222,990) in 2050 (Fig. 1), a 79% increase (IRR
1.79, 95% CI 1.78 to 1.80).
Palliative care needs by condition

Dementia and cardiovascular diseases are the conditions with the highest expected increase in the number ofpeople with palliative care needs. The number of people
with palliative care needs from dementia is expected toincrease from 17,851 (95% CI 17,449 to 18,271) in 2021
to 51,828 (95% CI 49,312 to 54,478) in 2050, representing a 190% increase (Table 3). The number of people withpalliative care needs from cardiovascular diseases is projected to increase from 17,038 (95% CI 16,706 to 17,380)
in 2021 to 31,689 (95% CI 30,441 to 32,992) by 2050, representing an 86% increase (Table 3).
In 2050, the estimated number of people with palliative care needs from cancer is 75,425 (95% CI 73,846 to
77,052). Both, decedents and non-decedents with palliative care needs from cancer conditions are expected toincrease 51% between 2021 and 2050. People with palliative care needs from chronic organ failure and communicable diseases are expected to increase by 74% (IRR 1.74,
95% CI 1.70 to 1.78) and 3% (IRR 1.03, 95% CI 1.00 to1.06) respectively (Table 3).

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Overall, the number of people with palliative careneeds from non-cancer conditions will be almost double the number of people with palliative care needs fromcancer conditions by 2050 (Fig. 2).

Discussion
Results from our analysis suggest the number of people with palliative care needs in Chile is going to almost
double by 2050. In absolute terms that means between
197,653 and 222,990 people might require palliative careby 2050. The number of people with palliative care needsfrom non-cancer conditions is higher, and is growing
faster, than those with cancer, mainly explained by the
projected increase in the number of people living anddying with dementia and cardiovascular conditions.
Our results suggest Chile is going to experience a significant increase in the number of people with palliative
care needs. This highlights the importance of expanding
high-quality service provision for the Chilean population.
These results align with global projections for uppermiddle income countries using the Lancet Commission
method [1]. Studies from other high-income countries
such as England, Wales and Scotland have estimatedsmaller increases in the number of people requiring palliative care (between a 25.4% and a 43%) [26, 27]. In Latin
America, dos Santos et al. estimated a 76% increase in thenumber of people with palliative care needs by 2040 in
Brazil, similar to our estimations [28].

Fig. 1 Estimated total (decedents and non-decedents) number of people with palliative care needs in Chile 1997-2050

Leniz et al. BMC Medicine(2024) 22:350

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Table 3 Predicted number of decedents and non-decedents with palliative care needs in Chile in 2021 and 2050 by group of
conditions
2021

2050

N (95% CI)

N (95% CI)

IRR (95% CI)*

CancerDecedents

26,086.5 (25,755.9–26,425.3)

39,521.1 (38,636.3–40,438.9)

1.52 (1.49–1.54)

Non-decedents

23,790.2 (23,530.3–24,053.8)

35,904.3 (35,209.4–36,613.3)

1.51 (1.48–1.53)

Total

49,876.7 (49,286.2–50,479.1)

75,425.4 (73,845.8–77,052.2)

1.51 (1.50–1.53)

Cardiovascular diseases
Decedents

11,673.1 (11,431.6–11,923.3)

26,242.0 (25,161.9–27,371.5)

2.25 (2.20–2.30)

Non-decedents

5364.4 (5274.1–5456.8)

5447.2 (5279.4–5620.4)

1.02 (0.98–1.05)

Total

17,037.5 (16,705.7–17,380.1)

31,689.2 (30,441.3–32,991.9)

1.86 (1.83–1.89)

Chronic organ failure
Decedents

10,714.9 (10,390.5–11,054.7)

18,620.3 (17,554.4–19,758.7)

1.74 (1.70–1.78)

Non-decedents

980.7 (910.5–1057.5)

1774.1 (1561.3–2016.4)

1.81 (1.67–1.96)

Total

11,695.6 (11,301.0–12,112.2)

20,394.3 (19,115.7–21,775.0)

1.74 (1.70–1.78)

Dementia
Decedents

3889.1 (3801.5–3980.5)

11,291.5 (10,743.3–11,868.9)

2.90 (2.80–3.01)

Non-decedents

13,961.8 (13,647.6–14,290.1)

40,536.4 (38,568.4–42,609.4)

2.90 (2.85–2.96)

Total

17,850.8 (17,449.1–18,270.6)

51,827.8 (49,311.7–54,478.3)

2.90 (2.85–2.95)

Communicable diseases
Decedents

786.0 (701.9–896.9)

1462.3 (761.5–3593.2)

1.86 (1.71–2.03)

Non-decedents

7785.9 (7174.6–8480.8)

7360.0 (5857.1–10,421.1)

0.95 (0.92–0.98)

Total

8572.0 (7876.5–9377.8)

8822.3 (6618.6–14,014.3)

1.03 (1.00–1.06)

Other
Decedents

4446.2 (4243.1–4671.8)

7671.4 (6888.6–8580.4)

1.73 (1.66–1.79)

Non-decedents

6985.6 (6706.5–7295.0)

12,666.0 (11,431.4–14,098.0)

1.81 (1.76–1.87)

Total

11,431.8 (10,949.6–11,966.8)

20,337.4 (18,320.0–22,678.4)

1.78 (1.74–1.82)*IRR of predicted numbers in 2050 versus 2021

Fig. 2 Estimated total (decedents and non-decedents) number of people with palliative care needs in Chile by cancer/non-cancer condition
and by condition category

Leniz et al. BMC Medicine(2024) 22:350

These projections are likely to be a reflection of theincrease in life expectancy and reduction in age-standardised mortality rate, observed and projected for most leading causes of death (including cardiovascular disease anddementia) in Chile and other Latin American countries[29–31]. This suggests population growth and ageing is
driving the projected increase in palliative care needs. Ourestimations suggest that by 2050 there will be around 130
thousand people in need of palliative care for non-cancer
conditions in Chile, almost double the number of people
with cancer conditions. Until now, service provision in Chile
has been organised to provide palliative care mainly forcancer patients [11]. While the introduction of the new lawthat guarantees the right to access palliative care services
for all patients with terminal conditions in Chile including
non-cancer conditions is welcome, there will need to be alarge expansion of palliative care services to meet the need.
A previous study estimated that the cost of providing palliative care in Chile is on average $4606 United States dollars(USD) per person for cancer and $2285 USD per person for
non-cancer conditions [11]. Our findings indicate that providing palliative care to comply with the new law will requirea large economic investment: assuming the cost per person
remains the same, the cost of providing care for cancer andnon-cancer conditions in 2050 will be approximately double
the cost of providing palliative care for only cancer conditions and three times larger than the cost of providing palliative care for only cancer patients in 2020.
These findings stress the importance of expanding
high-quality palliative care services for both cancer andnon-cancer conditions. According to the Latin American Atlas of Palliative Care, Chile had 244 palliative careservices in 2018, representing 13.4 palliative care services per million people [32]. A rise in specialist palliative
care units across the country and new models of palliative care needs optimised for non-cancer conditions areneeded. Models of care that integrate palliative care andprimary care teams have been shown to reduce symptom
burden, reduce hospital care and have been cost-effective
in non-cancer conditions and older adults [33–35]. Thisrequires increasing palliative care training among healthcare professionals both at undergraduate and postgraduate levels and enhancing the provision of palliative carein primary care through more training and resources [36,37]. However, to secure access to high-quality palliative
care for all patients in need, increased coverage should
be jointly addressed with strategies for evaluating andimproving the quality of care provided [38].
Based on past trends and population estimations, ourresults suggest the number of people living and dying withdementia who experience palliative care needs will increase
threefold by 2050. These findings are consistent with global
projections that suggest dementia is the condition with

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the highest proportional increase in serious-related suffering [1]. Moreover, it is likely the burden of dementia isunderestimated in our analysis due to under recognition ofdementia as an underlying or contributing cause of deathin death certificates [39]. Most people with dementia experiencing palliative care needs are people who will not diein the following year and might require palliative care forseveral years. Understanding how to provide good qualityof end-of-life care for people with dementia in this context
is key. Researchers are currently exploring models of palliative care for people with dementia in Australia, the UnitedStates of America (USA) and Europe [40–44]. However,there is an urgent need to understand how these models orinterventions might be translated to the Chilean context.
Strengths and limitations

This study has several strengths. We used data on alldeaths in Chile, adjusted by age and sex, and modelled
future projections based on past trends using more than
20 years of data, as well as including changes in population estimates. We used the Lancet Commission methods previously used for global estimations, and also in
the Chilean context, which facilitates comparisons. We
also included estimations of palliative care needs for nondecedents, which is important to provide a more realistic
estimation of service demand.
Estimating palliative care needs from death certificatesrecords has limitations, as it relies on the quality of records
and is sensitive to changes in medical certification and coding practices. The Lancet Commission weightings are basedon international expert consensus and might not be representative of Chilean symptom prevalence and care needs.
Non-decedents are estimated from decedent cases which do
not necessarily represent prevalent cases. Using a Poissonmodel allowed us to project future trends from past trends
while adjusting by age and sex and considering population
estimates. However linear estimations assume past trends
will remain stable which is not necessarily true. Changes inservice provision, disease prevalence and incidence, disease
trajectories and treatment, as well as new emergent diseases
such as COVID-19 might affect these trends, and therefore
long-term projections should be interpreted cautiously.

Conclusions
The number of people with palliative care needs in Chileis going to almost double by 2050. Palliative care needs
among people with non-cancer conditions are growing
faster than those with cancer, mainly explained by the projected increase in the number of people living and dying
with dementia and cardiovascular conditions. Improved
availability of services, palliative care training and newsustainable models of care are urgently required to ensure
universal access to palliative care for those who need it.

Leniz et al. BMC Medicine(2024) 22:350

Abbreviations
DEIS	Department of Health Information and Statistics
INE	Institute for National Statistics
ICD-10	International Statistical Classification of Diseases and Related Health
Problems 10th revision
CNS	Central nervous system
IRR	Incidence risk ratio
CI	Confidence interval
USD	United States dollars
USA	United States of America

Page 8 of 9

Author details
1
Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad
Católica de Chile, Santiago, Chile. 2 Cicely Saunders Institute of Palliative Care,
Policy and Rehabilitation, King’s College London, London, UK. 3 Departmentof Public Health and Primary Care, University of Cambridge, Cambridge, UK.
4
Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. 5 Sec‑
ción Medicina Paliativa, Escuela de Medicina, Pontificia Universidad Católica deChile, Santiago, Chile.
Received: 15 September 2023 Accepted: 19 August 2024

Supplementary Information
The online version contains supplementary material available at https://​doi.​
org/​10.​1186/​s12916-​024-​03570-1.
Additional file 1: Past Trends and future projections of palliative care needs
in Chile: analysis of routinely available death registry and population data.
Additional file 2: Methodology supplement.
Acknowledgements
We would like to thank Xiao-Xiao Jiang Kwete and Hector Arreola-Ornelasfor their important insights and help with the Lancet Commission on Global
Access to Palliative Care and Pain Relief methodology.
Authors’ contributions
JL and KES had the idea for the study. JL designed the study with inputs from
AEB, SE, PEP, AD and KES. JL conducted the analysis with statistical support
from AD. JL, AEB, SE, PEP, AD and KES helped to interpret the findings. JL
drafted the first manuscript and all the authors contributed to the following
drafts. JL acts as a guarantor for the paper. All authors read and approved thefinal manuscript.
Authors’ Twitter handles
Javiera Leniz, @jlenizmartelli; Anna E. Bone, @AnnaEBone; Simon Etkind, @SimonNoahEtkind; Katherine E. Sleeman, @kesleeman
Funding
No specific funding was used for this study. KES is the Laing Galazka Chair in
palliative care at King’s College London, funded through an endowment from
Cicely Saunders International and the Kirby Laing Foundation.
Availability of data and materials
Mortality data used in this study is available from the Department of Health
Information and Statistics (DEIS) website (https://​deis.​minsal.​cl/). Popula‑tion estimates used in this study are available from the Institute for National
Statistics (INE) website (https://​www.​ine.​gob.​cl/). Specific codes and weights
used to derive palliative care needs and Stata codes used in the analysis areavailable in Additional file 1. The last version of the data used for graphs andtables is available at:
Leniz Martelli, Javiera. Conjunto de datos: Past trends and future projections ofpalliative care needs in Chile: analysis of routinely available death registry andpopulation data. Datos de Investigación UC https://​doi.​org/​10.​60525/​04tey​
e511/​T44IRY. V1 (2024)

Declarations
Ethics approval and consent to participate.
This study was assessed by the Pontificia Universidad Católica de Chile Ethi‑
cal Committee (ID 230825001) and exempt from ethical approval as it usedpublicly available data for the analysis.
Consent for publication
The manuscript does not contain any individual person’s data in any form.
Therefore, no consent from patients is required.
Competing interests
None declared.

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