社会经济地位低下与癌症患者临终治疗期间临终关怀服务利用率较低相关：一项基于人群的队列研究。
Low Socioeconomic Status Associated With Lower Utilization of Hospice Care Services During End-of-Life Treatment in Patients With Cancer: A Population-Based Cohort Study.
作者信息
Lai Yun-Ju, Chen Yu-Yen, Ko Ming-Chung, Chou Yi-Sheng, Huang Li-Ying, Chen Yi-Tui, Hung Kuo-Chuan, Lin Yu-Kai, Wang Chun-Chieh, Chen Chu-Chieh, Chuang Pei-Hung, Yen Yung-Feng
机构信息
School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Endocrinology and Metabolism, Department of Internal Medicine, Puli Branch of Taichung Veterans General Hospital, Nantou, Taiwan; Department of Exercise Health Science, National Taiwan University of Sport, Taichung, Taiwan.
School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan.
出版信息
J Pain Symptom Manage. 2020 Aug;60(2):309-315.e1. doi: 10.1016/j.jpainsymman.2020.03.015. Epub 2020 Mar 30.
CONTEXT
Socioeconomic status (SES) is an important determinant of disparities in health services and may affect the utilization of hospice care services during end-of-life (EOL) treatment in patients with cancer. However, previous studies evaluating the association between SES and utilization of hospice care services among patients with cancer revealed inconsistent findings.
OBJECTIVES
This study aimed to determine the association between SES and utilization of hospice care services during the last year of life in patients with cancer.
METHODS
From January 1, 2006 to December 31, 2016, we identified adults with cancer diagnoses from the Registry for Catastrophic Illness in Taiwan. The cancer diagnoses in study subjects were proved by the pathohistological reports. The utilization of hospice care services during the last year of life in patients with cancer included hospice inpatient care, hospice-shared care, and hospice home care.
RESULTS
In the follow-up period, 28.6% of 516,409 patients with cancer used hospice care services during the last year of life. After adjusting for other covariates, low SES significantly reduced the utilization of hospice care services by 18% during the last year of life in patients with cancer. Moreover, a positive trend between decreasing levels of SES and lower utilization of hospice care during EOL treatment was noted (P < 0.001).
CONCLUSION
Low SES was associated with lower utilization of hospice care services during EOL care in patients with cancer. Our data support the need to target low SES patients with cancer in efforts to optimally increase hospice care services during EOL care.
背景
社会经济地位（SES）是健康服务差距的一个重要决定因素，可能会影响癌症患者临终（EOL）治疗期间临终关怀服务的利用情况。然而，先前评估SES与癌症患者临终关怀服务利用之间关联的研究结果并不一致。
目的
本研究旨在确定SES与癌症患者生命最后一年临终关怀服务利用之间的关联。
方法
从2006年1月1日至2016年12月31日，我们从台湾重大伤病登记处识别出患有癌症诊断的成年人。研究对象的癌症诊断由病理组织学报告证实。癌症患者生命最后一年临终关怀服务的利用情况包括临终关怀住院护理、临终关怀共享护理和临终关怀居家护理。
结果
在随访期间，516409名癌症患者中有28.6%在生命的最后一年使用了临终关怀服务。在调整其他协变量后，低SES显著降低了癌症患者生命最后一年临终关怀服务的利用率18%。此外，还注意到SES水平下降与临终治疗期间临终关怀服务利用率降低之间存在正相关趋势（P < 0.001）。
结论
低SES与癌症患者临终关怀期间临终关怀服务利用率较低有关。我们的数据支持在临终关怀期间针对低SES癌症患者，以最佳方式增加临终关怀服务的必要性。
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