Background. There is currently a push to move away from hospital-based end-of-life care, driven by the need to control healthcare costs and in line with the wishes and needs of the population. However, very few studies have been conducted in France to better identify the factors associated with deaths in hospitals. Method. The distribution of places of death was analyzed according to demographic and environmental factors using data from death certificates, supplemented by external data (density of medical services, density of nursing homes). The study, conducted as part of the work of the National End-of-Life Observatory in collaboration with the Inserm Center for Epidemiology on Medical Causes of Death, covered all deaths occurring in France between 1993 and 2008. Results. In 2008, 57% of deaths occurred in hospitals, 27% at home, 11% in nursing homes, and 5% in other locations. The proportion of deaths in hospitals has remained generally stable over the past 15 years. However, it tends to increase for deaths due to tumors and to decrease for diseases of the nervous system. It varies by age, cause of death, and region of residence, but is little affected by the density of medical services and nursing homes. Conclusion. This study highlights the high level of medicalization of end-of-life care in France compared to certain other European countries, particularly for tumors and cerebrovascular diseases. It also underscores significant regional variations in the frequency of deaths in hospitals, even after controlling for individual and environmental variables. (R.A.)