Duke University Division of Gynecologic Oncology, Department of Radiation Oncology, Durham, NC, United States of America.
Duke Cancer Institute, Department of Radiation Oncology, Durham, NC, United States of America.
Gynecol Oncol. 2019 Oct;155(1):98-104. doi: 10.1016/j.ygyno.2019.07.013. Epub 2019 Aug 1.
To evaluate associations between US region of residence and urbanization and the place of death among women with gynecologic malignancies in the United States.
A retrospective cross-sectional study was performed using publicly available death certificate data from the National Center for Health Statistics. All gynecologic cancer deaths were included from 2006 to 2016. Comparisons among categories were performed with a two-tailed chi-square test, with p-values <0.05 considered significant.
From 2006 to 2016, 328,026 women died from gynecologic malignancies in the US. Of these deaths, 40.1% (n = 134,333) occurred in the patient's home, 24.9%(n = 81,823) in the hospital, and 11.3% (37,188) in an inpatient hospice facility. Place of death varied by geographic region. The Northeast had the largest percentage of gynecologic cancer patients (31.3%) die as a hospital inpatient. The West had the highest percentage of deaths (49.3%) at home. Deaths in a hospice facility were the highest (14.1%) in the South. Place of death varied by urbanization; patients residing in large central metro or rural counties were the most likely to die during hospital admission (28.7% and 27.1%, respectively). Patients living in medium-sized metro areas were the least likely to die in hospitals (21.8%) and most likely to die in a hospice facility (14.3%). All comparisons were significant by study definition.
The place of death for patients with gynecologic malignancies varies by US region and urbanization. These disparities are multifactorial in nature, likely influenced by both sociodemographic factors and regional resource availability. In this study, however, rural and central metro areas are identified as regions that may benefit from further hospice development and advocacy.
评估美国女性妇科恶性肿瘤患者的居住地区和城市化与死亡地点之间的关联。
本研究采用美国国家卫生统计中心公开的死亡证明数据，进行回顾性的横截面研究。纳入了 2006 年至 2016 年期间所有的妇科癌症死亡病例。采用双侧卡方检验对各分类进行比较，p 值<0.05 认为具有统计学意义。
2006 年至 2016 年期间，美国有 328,026 名女性死于妇科恶性肿瘤。其中，40.1%（n=134,333）死于家中，24.9%（n=81,823）死于医院，11.3%（n=37,188）死于住院临终关怀机构。死亡地点因地理位置而异。东北地区的妇科癌症患者（31.3%）中有最大比例的人在医院住院期间死亡。西部地区在家中死亡的比例最高（49.3%）。在南方，临终关怀机构的死亡比例最高（14.1%）。死亡地点也因城市化程度而异；居住在大中城市中心或农村县的患者最有可能在住院期间死亡（分别为 28.7%和 27.1%）。居住在中等规模城市地区的患者在医院死亡的可能性最小（21.8%），在临终关怀机构死亡的可能性最大（14.3%）。根据研究定义，所有比较均具有统计学意义。
妇科恶性肿瘤患者的死亡地点因美国地区和城市化程度而异。这些差异是多方面的，可能受到社会人口因素和区域资源可用性的影响。然而，在这项研究中，农村和中心城市地区被确定为可能受益于进一步发展临终关怀和倡导的地区。
