McNamara Beverley, Rosenwax Loma
School of Social and Cultural Studies, The University of Western Australia, 35 Stirling Highway, CRAWLEY, Perth 6009, Australia.
Health Place. 2007 Jun;13(2):356-67. doi: 10.1016/j.healthplace.2006.03.001. Epub 2006 Jun 2.
Despite the growing international interest in place of death and its relationship to healthcare policy, virtually nothing is known about where people die in Australia. To address this gap our study employs a longitudinal, population-based retrospective cohort study of people who died in Western Australia over a 30-month period. Mortality, morbidity and palliative care service data sets from the Western Australian Data Linkage System were examined to provide demographic and disease-specific characteristics and healthcare service use in the last year of life for the 26882 people who died during this time. The main outcome variables of the study were accommodation setting at the time of death (usual place of residence, hospital, hospice, residential aged care facility and other) and specialist palliative care use (hospital, home-based, both or neither). Over half of Western Australians died in hospital, but as people age there is an increasing tendency to die in their usual place of residence, which may be a private residence or an aged care facility. People who accessed community-based specialist palliative care had a seven times higher chance of dying in their usual place of residence. Importantly, this information is provided, not just for cancer deaths, as has been the practice to date, but for a range of other painful and life-limiting conditions considered amenable to palliative care. The unique population data on palliative care service use, made possible by the data linkage system, provides a basis for planning health services and policies.
尽管国际上对死亡地点及其与医疗政策的关系越来越感兴趣，但对于澳大利亚人死亡的地点实际上却知之甚少。为了填补这一空白，我们的研究采用了一项基于人群的纵向回顾性队列研究，研究对象是在30个月内于西澳大利亚州死亡的人群。我们审查了西澳大利亚州数据链接系统中的死亡率、发病率和姑息治疗服务数据集，以提供这26882名在此期间死亡者在生命最后一年的人口统计学和特定疾病特征以及医疗服务使用情况。该研究的主要结果变量是死亡时的居住环境（通常居住地、医院、临终关怀机构、老年护理机构和其他）以及专科姑息治疗的使用情况（医院、居家、两者都用或两者都不用）。超过一半的西澳大利亚人在医院死亡，但随着年龄增长，在其通常居住地死亡的趋势日益增加，通常居住地可能是私人住宅或老年护理机构。接受社区专科姑息治疗的人在其通常居住地死亡的可能性高出七倍。重要的是，这些信息不仅适用于癌症死亡（这是迄今为止的惯例），还适用于一系列其他被认为适合姑息治疗的痛苦和危及生命的疾病。数据链接系统提供的关于姑息治疗服务使用情况的独特人群数据，为规划卫生服务和政策提供了依据。
