Sedhom Ramy, Kuo Pei-Lun, Gupta Arjun, Smith Thomas J, Chino Fumiko, Carducci Michael A, Bandeen-Roche Karen
Sidney Kimmel Comprehensive Cancer Center At Johns Hopkins, Baltimore, MD, United States of America.
Department of Epidemiology, Johns Hopkins University, Baltimore, MD, United States of America.
J Geriatr Oncol. 2021 Apr;12(3):361-367. doi: 10.1016/j.jgo.2020.10.008. Epub 2020 Oct 26.
Place of death is important to patients and caregivers, and often a surrogate measure of health care disparities. While recent trends in place of death suggest an increased frequency of dying at home, data is largely unknown for older adults with cancer.
Deidentified death certificate data were obtained via the National Center for Health Statistics. All lung, colon, prostate, breast, and pancreas cancer deaths for older adults (defined as >65 years of age) from 2003 to 2017 were included. Multinomial logistic regression was used to test for differences in place of death associated with sociodemographic variables.
From 2003 through 2017, a total of 3,182,707 older adults died from lung, colon, breast, prostate and pancreas cancer. During this time, hospital and nursing home deaths decreased, and the rate of home and hospice facility deaths increased (all p < 0.001). In multivariable regression, all assessed variables were found to be associated with place of death. Overall, older age was associated with increased risk of nursing facility death versus home death. Black patients were more likely to experience hospital death (OR 1.7) and Hispanic ethnicity had lower odds of death in a nursing facility (OR 0.55). Since 2003, deaths in hospice facilities rapidly increased by 15%.
Hospital and nursing facility cancer deaths among older adults with cancer decreased since 2003, while deaths at home and hospice facilities increased. Differences in place of death were noted for non-white patients and older adults of advanced age.
死亡地点对患者及其照料者很重要，并且常常是医疗保健差异的一项替代指标。虽然近期死亡地点的趋势表明在家中死亡的频率有所增加，但老年癌症患者的数据在很大程度上尚不清楚。
通过国家卫生统计中心获取经过身份识别处理的死亡证明数据。纳入了2003年至2017年所有65岁及以上老年人的肺癌、结肠癌、前列腺癌、乳腺癌和胰腺癌死亡病例。采用多项逻辑回归来检验与社会人口统计学变量相关的死亡地点差异。
从2003年到2017年，共有3182707名老年人死于肺癌、结肠癌、乳腺癌、前列腺癌和胰腺癌。在此期间，医院和养老院死亡人数减少，而家中和临终关怀机构死亡人数增加（所有p<0.001）。在多变量回归中，所有评估变量均与死亡地点相关。总体而言，与在家中死亡相比，年龄较大与在护理机构死亡的风险增加相关。黑人患者更有可能在医院死亡（比值比1.7），而西班牙裔在护理机构死亡的几率较低（比值比0.55）。自2003年以来，临终关怀机构的死亡人数迅速增加了15%。
自2003年以来，老年癌症患者在医院和护理机构的癌症死亡人数减少，而在家中和临终关怀机构的死亡人数增加。非白人患者和高龄老年人在死亡地点方面存在差异。
