End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
Bioethics Department, St George's University School of Medicine, St George's, Grenada.
J Epidemiol Community Health. 2020 Jun;74(7):580-585. doi: 10.1136/jech-2019-213285. Epub 2020 Apr 22.
Valuable information for planning future end-of-life care (EOLC) services and care facilities can be gained by studying trends in place of death (POD). Scarce data exist on the POD in small developing countries. This study aims to examine shifts in the POD of all persons dying between 1999 and 2010 in Trinidad and Tobago, to draw conclusions about changes in the distribution of POD over time and the possible implications for EOLC practice and policy.
A population-level analysis of routinely collected death certificate data of the most recent available fully coded years at the time of the study-1999 to 2010. Observed proportions for the POD of all deaths were standardised according to the age, sex and cause of death distribution in 1999. Trends for a subgroup of persons who died from causes indicative of a palliative care (PC) need were also examined.
The proportion of deaths in government hospitals increased from 48.9% to 55.4% and decreased from 38.7% to 29.7% at private homes. There was little variation between observed and standardised rates. The decrease in home deaths was stronger when the PC subcategory was considered, most notably from cancer.
Internationally, the proportion of deaths at institutions is increasing. A national strategy on palliative and EOLC is needed to facilitate the increasing number of people who seek EOLC at government hospitals in Trinidad and Tobago, including an investigation into the reasons for the trend. Alternatives to accommodate out-of-hospital deaths can be considered.
通过研究死亡地点（POD）的趋势，可以获得有关规划未来临终关怀（EOLC）服务和护理设施的宝贵信息。在小的发展中国家，关于 POD 的数据很少。本研究旨在检查 1999 年至 2010 年期间特立尼达和多巴哥所有死亡者的 POD 变化，总结 POD 随时间的分布变化及其对 EOLC 实践和政策的可能影响。
对研究期间最新的全编码年份（1999 年至 2010 年）的常规收集死亡证明数据进行人群水平分析。根据 1999 年的年龄、性别和死因分布，对所有死亡者的 POD 观察比例进行标准化。还检查了一个代表有姑息治疗（PC）需求的死因的亚组人群的 POD 趋势。
公立医院的死亡比例从 48.9%增加到 55.4%，而私人住宅的死亡比例从 38.7%下降到 29.7%。观察到的和标准化的比率之间几乎没有差异。当考虑到 PC 亚组时，家庭死亡人数的减少更为明显，尤其是癌症。
在国际上，医疗机构的死亡比例正在增加。特立尼达和多巴哥需要制定姑息治疗和 EOLC 国家战略，以促进越来越多的人在政府医院寻求 EOLC，包括对这一趋势的原因进行调查。可以考虑其他替代方案来容纳院外死亡。
