Interdepartmental Division of Critical Care Medicine (Yarnell, Fowler), Department of Medicine, University of Toronto; Mount Sinai Hospital (Yarnell); Institute of Health Policy, Management and Evaluation (Yarnell, Nayfeh, Fowler), University of Toronto; ICES (Fu); Division of Palliative Medicine (Bonares), Department of Medicine, University of Toronto; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.
CMAJ. 2020 Mar 16;192(11):E266-E274. doi: 10.1503/cmaj.190655.
Ethnicity may be associated with important aspects of end-of-life care, such as what treatments are received, access to palliative care and where people die. However, most studies have focused on end-of-life care of white, Hispanic and black patients. We sought to compare end-of-life care delivered to people of Chinese and South Asian ethnicity with that delivered to others from the general population, in Ontario, Canada.
In this population-based cohort study, we included all people who died in Ontario, Canada, between Apr. 1, 2004, and Mar. 31, 2015. People were identified as having Chinese or South Asian ethnicity on the basis of a validated surname algorithm. We used modified Poisson regression analyses to assess location of death and care received in the last 6 months of life.
We analyzed 967 339 decedents, including 18 959 (2.0%) of Chinese and 11 406 (1.2%) of South Asian ethnicity. Chinese (13.6%) and South Asian (18.5%) decedents were more likely than decedents from the general population (10.1%) to die in the intensive care unit (ICU). The adjusted relative risk of dying in intensive care was 1.21 (95% confidence interval [CI] 1.15 to 1.27) for Chinese and 1.25 (95% CI 1.20 to 1.30) for South Asian decedents. In their last 6 months of life, decedents of Chinese and South Asian ethnicity experienced significantly more ICU admission, hospital admission, mechanical ventilation, dialysis, percutaneous feeding tube placement, tracheostomy and cardiopulmonary resuscitation than the general population.
Decedents of Chinese and South Asian ethnicity in Ontario were more likely than decedents from the general population to receive aggressive care and to die in an ICU. These findings may be due to communication difficulties between patients and clinicians, differences in preferences about end-of-life care or differences in access to palliative care services.
族裔可能与临终关怀的许多重要方面相关，例如接受哪些治疗、获得姑息治疗的机会以及死亡地点等。然而，大多数研究都集中在白种人、西班牙裔和非裔美国人的临终关怀上。我们试图比较在安大略省，接受族裔为华裔和南亚裔的人与一般人群接受的临终关怀。
在这项基于人群的队列研究中，我们纳入了 2004 年 4 月 1 日至 2015 年 3 月 31 日期间在安大略省去世的所有人。根据经过验证的姓氏算法，将人们确定为华裔或南亚裔。我们使用改良泊松回归分析评估临终前 6 个月的死亡地点和所接受的护理。
我们分析了 967339 名死者，包括 18959 名（2.0%）华裔和 11406 名（1.2%）南亚裔。与一般人群（10.1%）相比，华裔（13.6%）和南亚裔（18.5%）死者更有可能在重症监护病房（ICU）死亡。华裔死者的 ICU 死亡率调整后相对风险为 1.21（95%置信区间 [CI] 1.15 至 1.27），南亚裔死者为 1.25（95% CI 1.20 至 1.30）。在他们生命的最后 6 个月，华裔和南亚裔死者比一般人群经历了更多的 ICU 入院、住院、机械通气、透析、经皮胃管置入、气管切开和心肺复苏。
安大略省的华裔和南亚裔死者比一般人群更有可能接受积极的治疗，并在 ICU 死亡。这些发现可能是由于患者与临床医生之间的沟通困难、对临终关怀偏好的差异或姑息治疗服务的获取差异所致。
