Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua, Italy.
Epidemiological Service, Health Directorate, Friuli Venezia Giulia Region, Udine, Italy.
PLoS One. 2019 Feb 7;14(2):e0212086. doi: 10.1371/journal.pone.0212086. eCollection 2019.
There is a heterogeneous literature on healthcare utilization patterns at the end of life. The objective of this study is to examine the impact of closeness to death on the utilization of acute hospital-based healthcare services and some primary healthcare services and compare differences in gender, age groups and major causes of death disease specific mortality.
A matched case-control study, nested in a cohort of 411,812 subjects, linked to administrative databases was conducted. All subjects were residents in the Friuli Venezia Giulia Region (Italy), born before 1946, alive in January 2000 and were followed up to December 2014. Overall, 158,571 decedents/cases were matched by gender and year of birth to one control, alive at least one year after their matched case's death (index-date). Hospital admissions, emergency department visits, drug prescriptions, specialist visits and laboratory tests that occurred 365 days before death/index-date, have been evaluated. Odds Ratios (ORs) for healthcare utilization were estimated through conditional regression models, further adjusted for Charlson Comorbidity Index and stratified by gender, age groups and major causes of death.
Decedents were significantly more likely of having at least one hospital admission (OR 7.0, 6.9-7.1), emergency department visit (OR 5.2, 5.1-5.3), drug prescription (OR 2.8, 2.7-2.9), specialist visit (OR 1.4, 1.4-1.4) and laboratory test (OR 2.7, 2.6-2.7) than their matched surviving counterparts. The ORs were generally lower in the oldest age group (95+) than in the youngest (55-74). Healthcare utilization did not vary by sex, but was higher in subjects who died of cancer.
Closeness to death appeared to be strongly associated with healthcare utilization in adult/elderly subjects. The risk seems to be greater among younger age groups than older ones, especially for acute based services. Reducing acute healthcare at the EOL represents an important issue to improve the quality of life in proximity to death.
关于生命末期的医疗保健利用模式存在着大量异质文献。本研究的目的是考察接近死亡对急性医院为基础的医疗保健服务和一些初级保健服务的利用的影响，并比较性别、年龄组和主要死因疾病特异性死亡率方面的差异。
在一个包含 411812 名受试者的队列中进行了嵌套的病例对照研究，并与行政数据库相关联。所有受试者均为意大利弗留利-威尼斯朱利亚地区的居民，出生于 1946 年前，2000 年 1 月仍存活，并随访至 2014 年 12 月。总体而言，根据性别和出生年份，将 158571 名死者/病例与一名至少在其匹配病例死亡后存活一年以上的对照者（索引日期）相匹配。评估了在死亡/索引日期前 365 天内发生的住院、急诊就诊、药物处方、专科就诊和实验室检查。通过条件回归模型估计医疗保健利用的优势比（OR），并进一步根据 Charlson 合并症指数进行调整，并按性别、年龄组和主要死因进行分层。
死者更有可能至少有一次住院（OR 7.0，6.9-7.1）、急诊就诊（OR 5.2，5.1-5.3）、药物处方（OR 2.8，2.7-2.9）、专科就诊（OR 1.4，1.4-1.4）和实验室检查（OR 2.7，2.6-2.7），与他们匹配的存活对照组相比。在最年长的年龄组（95 岁以上），OR 一般低于最年轻的年龄组（55-74 岁）。性别之间的医疗保健利用没有差异，但死于癌症的患者更高。
接近死亡似乎与成年/老年患者的医疗保健利用密切相关。在年轻年龄组中，风险似乎大于年长年龄组，尤其是对于急性服务。减少生命末期的急性医疗保健是改善接近死亡时生活质量的一个重要问题。
