Cross Sarah H, Ely E Wesley, Kavalieratos Dio, Tulsky James A, Warraich Haider J
Sanford School of Public Policy, Duke University, Durham, NC.
Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, TN; VA Tennessee Valley Geriatric Research Education Clinical Center, Nashville, TN; Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University, Nashville, TN.
Chest. 2020 Aug;158(2):670-680. doi: 10.1016/j.chest.2020.02.062. Epub 2020 Mar 27.
Although chronic lung disease is a common cause of mortality, little is known about where individuals with chronic lung disease die.
The aim of this study was to determine the trends and factors associated with place of death among individuals with chronic lung disease.
This cross-sectional analysis of natural deaths was conducted by using the Centers for Disease Control and Prevention Wide-ranging OnLine Data for Epidemiologic Research from 2003 to 2017 for which COPD, interstitial lung disease (ILD), or cystic fibrosis (CF) was the underlying cause. Place of death was categorized as hospital, home, nursing facility, hospice facility, and other.
From 2003 to 2017, more than 2.2. million deaths were primarily attributed to chronic lung disease (51.6% female, 92.4% white). Most were attributed to COPD (88.9%), followed by ILD (10.8.%), and CF (0.3%). Hospital and nursing facility deaths declined from 44.4% (n = 59,470) and 22.6% (n = 30,285) to 28.3% (n = 49,655) and 19.7% (n = 34,495), while home and hospice facility deaths increased from 23.3% (n = 31,296) and 0.1% (n = 192) to 34.7% (n = 60,851) and 9.0% (n = 15,861), respectively. Male sex, being married, and having some college education were associated with increased odds of home death, whereas non-white race and Hispanic ethnicity were associated with increased odds of hospital death. Compared with individuals with COPD, individuals with ILD and CF had increased odds of hospital death and reduced odds of home, nursing facility, or hospice facility death.
Home deaths are rising among decedents from chronic lung disease, increasing the need for quality end-of-life care in this setting. Further research should explore the end-of-life needs and preferences of these patients and their caregivers, with particular attention paid to patients with ILD and CF who continue to have high rates of hospital death.
尽管慢性肺病是常见的死亡原因，但对于慢性肺病患者的死亡地点却知之甚少。
本研究的目的是确定慢性肺病患者的死亡地点趋势及相关因素。
本横断面自然死亡分析使用了美国疾病控制与预防中心2003年至2017年的广泛在线流行病学研究数据，其中慢性阻塞性肺疾病（COPD）、间质性肺疾病（ILD）或囊性纤维化（CF）为根本死因。死亡地点分为医院、家中、护理机构、临终关怀机构及其他。
2003年至2017年期间，超过220万例死亡主要归因于慢性肺病（女性占51.6%，白人占92.4%）。大多数归因于COPD（88.9%），其次是ILD（10.8%）和CF（0.3%）。医院和护理机构死亡比例从44.4%（n = 59470）和22.6%（n = 30285）降至28.3%（n = 49655）和19.7%（n = 34495），而家中和临终关怀机构死亡比例分别从23.3%（n = 31296）和0.1%（n = 192）增至34.7%（n = 60851）和9.0%（n = 15861）。男性、已婚以及接受过一些大学教育与在家中死亡的几率增加相关，而非白人种族和西班牙裔与在医院死亡的几率增加相关。与COPD患者相比，ILD和CF患者在医院死亡的几率增加，而在家中、护理机构或临终关怀机构死亡的几率降低。
慢性肺病死者在家中死亡的比例正在上升，这增加了在此情况下提供高质量临终护理的需求。进一步的研究应探索这些患者及其护理者的临终需求和偏好，尤其要关注医院死亡比例仍然较高的ILD和CF患者。
