Prevalence and influencing factors of end-of-life symptoms among hospital decedents in South Korea: A cross-sectional secondary analysis

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.