Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Palliative Care Team, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.
J Epidemiol Community Health. 2019 May;73(5):435-442. doi: 10.1136/jech-2018-211580. Epub 2019 Feb 2.
In Denmark, patients who are terminally ill have the right to drug reimbursement due to terminal illness (DRTI). DRTI, a proxy marker of planned end-of-life care, is intended to be equally accessible regardless of socioeconomic position. This study examined social and socioeconomic differences in DRTI among Danish patients who are terminally ill.
This cross-sectional study based on individual-level nationwide data included all patients dying from cancer, dementia, ischaemic heart disease, chronic obstructive pulmonary disease, chronic liver disease, congestive heart failure, diabetes or stroke in 2006-2015 (n=307 188). We analysed associations between social and socioeconomic position (education, income, cohabiting status, migrant status and employment) and DRTI. Prevalence ratios (PR) and 95% CIs were estimated using log-linear models adjusted for age, gender, comorbidity, cause of death and residence.
Overall, 27.9% of patients received DRTI (n=85 616). A substantial difference in likelihood of receiving DRTI was observed among patients with a social and socioeconomic profile associated with the highest versus lowest probability of DRTI (adjusted PR 1.44, 95% CI 1.18 to 1.75). The probability of DRTI was higher among patients with high income compared with low income (adjusted PR 1.22, 95% CI 1.17 to 1.26). Also, living with a partner and being immigrant or descendant of such were associated with higher probability of DRTI compared with living alone and of Danish origin, whereas employment was associated with lower probability of DRTI compared with retirement.
Social and socioeconomic position was associated with the likelihood of receiving DRTI, which indicates that planned end-of-life care is not equally accessible in Denmark.
在丹麦，绝症患者有权获得因绝症而给予的药物补偿（DRTI）。DRTI 是临终关怀计划的替代指标，旨在让所有绝症患者都能平等地获得这种补偿，无论其社会经济地位如何。本研究旨在调查丹麦绝症患者接受 DRTI 的社会和社会经济差异。
这是一项基于个体层面全国性数据的横断面研究，纳入了 2006 年至 2015 年期间死于癌症、痴呆、缺血性心脏病、慢性阻塞性肺疾病、慢性肝病、充血性心力衰竭、糖尿病或中风的所有患者（n=307188）。我们分析了社会和社会经济地位（教育程度、收入、同居状况、移民身份和就业状况）与 DRTI 之间的关联。使用调整了年龄、性别、合并症、死因和居住地的对数线性模型来估计患病率比（PR）和 95%置信区间（CI）。
总体而言，27.9%的患者接受了 DRTI（n=85616）。在与 DRTI 发生可能性最高和最低相关的社会和社会经济特征的患者中，接受 DRTI 的可能性存在显著差异（调整后 PR 1.44，95%CI 1.18 至 1.75）。与低收入相比，高收入患者接受 DRTI 的可能性更高（调整后 PR 1.22，95%CI 1.17 至 1.26）。此外，与独居和丹麦血统相比，与伴侣同住和移民或移民后代更有可能接受 DRTI，而与退休相比，就业与接受 DRTI 的可能性较低相关。
社会和社会经济地位与接受 DRTI 的可能性相关，这表明丹麦的临终关怀计划并非平等可得。
