Cárdenas-Turanzas Marylou, Carrillo María Teresa, Tovalín-Ahumada Horacio, Elting Linda
Department of Biostatistics and Applied Mathematics, The University of Texas, M.D. Anderson Cancer Center, 1515 Holcombe Blvd Unit 447, Houston, TX 77030, USA.
Support Care Cancer. 2007 Mar;15(3):243-9. doi: 10.1007/s00520-006-0152-4. Epub 2006 Oct 5.
To improve the care of cancer patients by understanding the factors associated with the place of death.
We conducted a retrospective study of death certificates registered in Mexico during 2003. Adult cases were included if the underlying cause of death was cancer, death location was in the Mexico City Metropolitan Area (MCMA), and information was available on sociodemographic characteristics and place of death (home or medical unit).
Of the 10,561 cases meeting the inclusion criteria, 54% died at home. More women (55%) than men died of cancer and at a younger age (63 vs 64 years, respectively; p<0.001). Multivariate analysis indicated that patients diagnosed with leukemia and lymphoma were 3.6 times more likely to die in hospitals than patients diagnosed with other cancers (p<0.001). Compared with patients who died at home, patients who died in hospitals were significantly more educated, younger, and residents of counties with more hospital beds density (p<0.001, p<0.001, and p=0.003, respectively). Certificates for in-hospital deaths were more likely to be signed by other physician or health professional than were those for at-home deaths (p<0.001). Cases with usual residency located outside the study area were 27 times more likely to die in hospitals than were metropolitan-area residents (p<0.001).
Patients dying at home tended to be of older age, less educated, diagnosed with prostate, urinary tract or gastrointestinal cancers, and residents of the MCMA. Health planners should consider determinants of place of death when allocating hospital or home-based palliative care units.
通过了解与死亡地点相关的因素来改善癌症患者的护理。
我们对2003年在墨西哥登记的死亡证明进行了一项回顾性研究。纳入标准为成年病例，其根本死因是癌症，死亡地点在墨西哥城大都市区（MCMA），且有社会人口学特征和死亡地点（家中或医疗机构）的相关信息。
在符合纳入标准的10561例病例中，54%在家中死亡。死于癌症的女性（55%）多于男性，且死亡年龄更年轻（分别为63岁和64岁；p<0.001）。多变量分析表明，诊断为白血病和淋巴瘤的患者在医院死亡的可能性是诊断为其他癌症患者的3.6倍（p<0.001）。与在家中死亡的患者相比，在医院死亡的患者受教育程度显著更高、年龄更年轻，且所在县的医院床位密度更大（分别为p<0.001、p<0.001和p=0.003）。医院死亡证明比家中死亡证明更有可能由其他医生或卫生专业人员签署（p<0.001）。常住地在研究区域外的病例在医院死亡的可能性是大都市区居民的27倍（p<0.001）。
在家中死亡的患者往往年龄较大、受教育程度较低，被诊断患有前列腺癌、泌尿系统癌或胃肠道癌，且是MCMA的居民。卫生规划者在分配医院或居家姑息治疗单位时应考虑死亡地点的决定因素。
