Ikeda Takaaki, Tsuboya Toru
Department of Health Policy Science, Graduate School of Medical Science, Yamagata University, Yamagata, Japan.
Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan.
Ann Geriatr Med Res. 2021 Mar;25(1):25-32. doi: 10.4235/agmr.21.0003. Epub 2021 Mar 29.
Although more than half of the population of Japan wants to spend their last days at home, approximately only 10% are able to do so. This study examined the associations between death at home and healthcare facility density by municipality based on the analysis of nationwide observed data in Japan.
We used data on deaths at home and healthcare resources in municipalities across Japan for the fiscal years 2014 and 2017. The proportions of deaths at home by municipality were used as the dependent variable, while healthcare resources (e.g., hospital density) divided by the population of older people in each municipality and municipality-level income were used as independent variables. We applied a fixed-effects regression analysis to examine the association of healthcare resources and municipality-level income with death at home.
Clinics providing home medical care and facilities providing visiting nursing services were positively associated with death at home, with coefficients (95% confidence intervals) of 2.14 (1.12 to 3.15) and 2.19 (0.99 to 3.39), respectively. Stratified analysis showed that these associations were observed in higher income-level municipalities but not in lower income-level municipalities.
Municipalities with a higher density of home care services had higher rates of death at home, whereas municipalities with a higher density of hospitals had lower rates. We recommend the development of policy that allows hospitals to be converted into home care providers so that more people can spend time in peace at home at the end of their lives.
尽管超过一半的日本人口希望在家中度过最后的日子，但大约只有10%的人能够如愿。本研究基于对日本全国观测数据的分析，考察了按市划分的在家死亡与医疗保健机构密度之间的关联。
我们使用了2014财年和2017财年日本各市在家死亡情况及医疗资源的数据。以各市在家死亡的比例作为因变量，将各市的医疗资源（如医院密度）除以老年人人口数以及市级收入作为自变量。我们应用固定效应回归分析来考察医疗资源和市级收入与在家死亡之间的关联。
提供居家医疗护理的诊所和提供上门护理服务的机构与在家死亡呈正相关，系数（95%置信区间）分别为2.14（1.12至3.15）和2.19（0.99至3.39）。分层分析表明，这些关联在高收入水平的市中存在，但在低收入水平的市中不存在。
居家护理服务密度较高的市在家死亡比例较高，而医院密度较高的市在家死亡比例较低。我们建议制定政策，允许医院转变为居家护理提供者，以便更多人能够在生命的最后时光在家中平静地度过。
