Neergaard Mette Asbjoern, Jensen Anders Bonde, Sokolowski Ineta, Olesen Frede, Vedsted Peter
The Palliative Team, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.
BMJ Support Palliat Care. 2012 Jun;2(2):133-9. doi: 10.1136/bmjspcare-2011-000116. Epub 2012 Mar 1.
Most terminally ill patients and relatives prefer care and death to occur at home. However, in many cases patients die in hospital and the question arises whether social inequity in palliative care exists. The aim of this study was to analyse associations between dying at home and demographic and socioeconomic characteristics adjusted for healthcare utilisation among Danish cancer patients.
Population-based, cross-sectional register study in Aarhus County, Denmark. 599 deceased adults who died from cancer from 1 March to 30 November 2006 in a well-defined geographical area were identified. Based on unique personal identifier numbers, socioeconomic data and healthcare utilisation from different registers were retrieved and analysed.
Multivariate analysis showed that dying at home was negatively associated with, first, being either 50-59 (prevalence ratio (PR): 0.67 (95% CI 0.45 to 0.99)) or 70-79 years of age (PR: 0.83 (95% CI 0.70 to 0.99)) compared with being 80 years or above; second, a middle personal income compared with a high income (PR: 0.86 (95% CI 0.75 to 1.00)); and, third, being employed or having a leadership position compared with being unemployed/student/receiving social security (PR: 0.72 (95% CI 0.53 to 0.98)).
The found socioeconomic differences in whether death occurred at home or at institutions indicate that age, income and social class must be taken into account when palliative care services engage in fulfilling preferences of dying at home. This may lead to more equality in the possibility of dying at home, despite differences in socioeconomic level.
大多数晚期患者及其亲属希望在自己家中接受护理并离世。然而，在许多情况下患者却在医院死亡，于是姑息治疗中的社会不平等问题便随之而来。本研究旨在分析丹麦癌症患者在家中离世与人口统计学及社会经济特征之间的关联，并对医疗保健利用情况进行校正。
在丹麦奥胡斯郡开展基于人群的横断面登记研究。确定了2006年3月1日至11月30日期间在一个明确界定的地理区域内因癌症死亡的599名成年死者。基于唯一的个人身份识别号码，从不同登记处检索并分析了社会经济数据和医疗保健利用情况。
多变量分析显示，与80岁及以上患者相比，在家中离世与以下因素呈负相关：其一，年龄在50 - 59岁（患病率比值（PR）：0.67（95%置信区间0.45至0.99））或70 - 79岁（PR：0.83（95%置信区间0.70至0.99））；其二，中等个人收入与高收入相比（PR：0.86（95%置信区间0.75至1.00））；其三，就业或担任领导职务与失业/学生/领取社会保障相比（PR：0.72（95%置信区间0.53至0.98））。
在家中或机构中死亡方面所发现的社会经济差异表明，姑息治疗服务在满足在家中离世的偏好时，必须考虑年龄、收入和社会阶层因素。尽管社会经济水平存在差异，但这可能会使在家中离世的可能性更加平等。
