Department of Obstetrics & Gynecology, Tufts Medical Center, Massachusetts General Hospital, and Brigham and Women's Hospital, Boston, Massachusetts; and MD Anderson Cancer Center, Houston, Texas.
Obstet Gynecol. 2018 Jun;131(6):1111-1120. doi: 10.1097/AOG.0000000000002614.
To describe the change over time in place of death (hospital, home, hospice) among all women in the United States who died of gynecologic malignancies and compare them with other leading causes of female cancer deaths.
This is a retrospective cross-sectional study using national death certificate data from the Mortality Multiple Cause-of-Death Public Use Record Data. All women who died from gynecologic, breast, lung, and colorectal cancers were identified according to International Classification of Diseases, 10 Revision, cause of death from 2003 to 2015. Regression analyses with ordinary least-squares linear probability modeling were used to test for differences in location of death over time, and differences in trends by cancer type, while controlling for age, race, ethnicity, marital status, and education status.
From 2003 to 2015, 2,133,056 women died from gynecologic, lung, breast, and colorectal malignancies in the United States. A total of 359,340 died from gynecologic malignancies, including ovarian cancer (n=188,366 [52.4%]), uterine cancer (n=106,454 [29.6%]), cervical cancer (n=52,320 [14.6%]), and vulvar cancer (n=12,200 [3.4%]). Overall, 49.2% (n=176,657) of gynecologic cancer deaths occurred at home or in hospice. The relative increase from 2003 to 2015 in the rate of deaths at home or in hospice was 47.2% for gynecologic cancer deaths (40.5% in 2003 to 59.5% in 2015). In adjusted analyses, the trend in the percentage of deaths at home or in hospice increased at a rate of 1.6 percentage points per year for gynecologic cancer deaths (95% CI 1.5-1.6) vs 1.5 (95% CI 1.4-1.5, P<.001), 1.4 (95% CI 1.4-1.5, P<.001), and 1.5 (95% CI 1.4-1.5, P=.09) percentage points per year for lung, breast, and colorectal cancer deaths, respectively.
Between 2003 and 2015, there was a 47.2% increase (40.5-59.5%) in the rates of gynecologic cancer deaths occurring at home or in hospice. This trend may represent an increase in advance care planning and value-based treatment decisions.
描述美国所有死于妇科恶性肿瘤的女性在不同时间的死亡地点（医院、家中、临终关怀）的变化，并将其与其他女性癌症死亡的主要原因进行比较。
这是一项使用 2003 年至 2015 年《国际疾病分类》第 10 次修订版死因的国家死亡证明数据进行的回顾性横截面研究。根据国际疾病分类，所有死于妇科、乳腺、肺和结直肠癌症的女性都被确定为癌症死亡原因。使用普通最小二乘法线性概率模型进行回归分析，以检验随时间推移的死亡地点差异，并控制年龄、种族、民族、婚姻状况和教育程度后，检验癌症类型的趋势差异。
2003 年至 2015 年，美国共有 2133056 名女性死于妇科、肺、乳腺和结直肠恶性肿瘤。共有 359340 名女性死于妇科恶性肿瘤，其中卵巢癌（n=188366 [52.4%]）、子宫癌（n=106454 [29.6%]）、宫颈癌（n=52320 [14.6%]）和外阴癌（n=12200 [3.4%]）。总体而言，49.2%（n=176657）的妇科癌症死亡发生在家庭或临终关怀中。2003 年至 2015 年，妇科癌症死亡在家中或临终关怀中死亡的比例相对增加了 47.2%（2003 年为 40.5%，2015 年为 59.5%）。在调整后的分析中，妇科癌症死亡在家中或临终关怀中死亡的比例呈每年增加 1.6 个百分点的趋势（95%CI 1.5-1.6），而肺癌、乳腺癌和结直肠癌死亡的比例分别为每年增加 1.5（95%CI 1.4-1.5，P<.001）、1.4（95%CI 1.4-1.5，P<.001）和 1.5（95%CI 1.4-1.5，P=.09）个百分点。
2003 年至 2015 年间，在家中或临终关怀中死亡的妇科癌症死亡率上升了 47.2%（40.5-59.5%）。这一趋势可能代表着提前护理计划和基于价值的治疗决策的增加。
