Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, King's College London, London, UK.
Palliat Med. 2013 Oct;27(9):840-6. doi: 10.1177/0269216313490436. Epub 2013 Jun 4.
Little is known about place of death in chronic neurological diseases. Mortality statistics are ideal for examining trends in place of death, but analyses are limited by coding rule changes.
To examine the relationship between place of death and underlying cause of death in Parkinson's disease, multiple sclerosis and motor neurone disease and the impact of coding rule changes on analysis of place of death.
Population-based study. Proportion ratios for death in hospice, home, care home and hospital were calculated according to underlying cause of death, using multivariable Poisson regression.
Deaths in England (1993-2010) with any mention of Parkinson's disease, multiple sclerosis or motor neurone disease as a cause of death, identified from national mortality data.
In this study, 125,242 patients with Parkinson's disease, 23,501 with multiple sclerosis, and 27,030 with motor neurone disease were included. Home deaths ranged from 9.7% (Parkinson's disease) to 27.1% (motor neurone disease), hospice deaths ranged from 0.6% (Parkinson's disease) to 11.2% (motor neurone disease) and hospital deaths ranged from 43.4% (Parkinson's disease) to 55.8% (multiple sclerosis). In Parkinson's disease and multiple sclerosis, cancer as underlying cause of death increased likelihood of hospice death (proportion ratio (PR): 18.8, 95% confidence interval (CI) = 16.1-22.0; 8.88, 95% CI = 7.49-10.5) and home death (PR: 1.91, 95% CI = 1.80-2.04; 1.71, 95% CI = 1.56-1.88). Dementia as underlying cause of death increased likelihood of care home death in Parkinson's disease (PR: 1.25, 95% CI = 1.19-1.32), multiple sclerosis (PR: 1.73, 95% CI = 1.22-2.45) and motor neurone disease (PR: 2.36, 95% CI = 1.31-4.27).
Underlying cause of death has a marked effect on place of death. The effects of coding rule changes are an essential consideration for all research using underlying cause of death to study place of death.
关于慢性神经疾病患者的死亡地点，人们知之甚少。死亡率统计数据非常适合用于研究死亡地点的趋势，但由于编码规则的变化，分析受到了限制。
检查帕金森病、多发性硬化症和运动神经元病的死亡地点与根本死因之间的关系，以及编码规则变化对死亡地点分析的影响。
基于人群的研究。根据根本死因，使用多变量泊松回归计算临终关怀、家庭、养老院和医院死亡的比例比。
英格兰（1993-2010 年）的死亡人数，任何提到帕金森病、多发性硬化症或运动神经元病作为死因的人，均从国家死亡率数据中确定。
本研究纳入了 125242 例帕金森病患者、23501 例多发性硬化症患者和 27030 例运动神经元病患者。家庭死亡比例从 9.7%（帕金森病）到 27.1%（运动神经元病），临终关怀死亡比例从 0.6%（帕金森病）到 11.2%（运动神经元病），医院死亡比例从 43.4%（帕金森病）到 55.8%（多发性硬化症）。在帕金森病和多发性硬化症中，癌症作为根本死因增加了临终关怀死亡的可能性（比例比（PR）：18.8，95%置信区间（CI）=16.1-22.0；8.88，95%CI=7.49-10.5）和家庭死亡（PR：1.91，95%CI=1.80-2.04；1.71，95%CI=1.56-1.88）。痴呆症作为根本死因，增加了帕金森病（PR：1.25，95%CI=1.19-1.32）、多发性硬化症（PR：1.73，95%CI=1.22-2.45）和运动神经元病（PR：2.36，95%CI=1.31-4.27）患者入住养老院的可能性。
根本死因对死亡地点有显著影响。编码规则变化的影响是使用根本死因研究死亡地点的所有研究的一个重要考虑因素。
