Department of Oncology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
School of Behavioral Sciences, The Academic College of Tel Aviv-Yafo, Rabenu Yeruham St, 86162, Yaffo, Israel.
Int J Equity Health. 2021 Apr 10;20(1):99. doi: 10.1186/s12939-021-01437-y.
Most cancer patients prefer to die at home; however, many die in hospital. The aim of the current study is to elucidate the association between dying at home and various personal factors in the Israeli population of cancer patients.
Data on cancer incidence (2008-2015) and death (2008-2017) was provided by the Israeli Central Bureau of Statistics and the Israel National Cancer Registry. Binary logistic regression analyses were performed to assess odds ratios for death at home following cancer diagnosis while controlling for age, sex, ethnicity, years of education, residential socioeconomic score, and time from diagnosis. We also assessed the relation between place of death and specific cancer sites, as well as the time trend from 2008 to 2017.
About one quarter (26.7%) of the study population died at home. Death at home was most frequent among patients diagnosed with brain tumors (37.0%), while it was the lowest among patients with hematologic malignancies (lymphoma and leukemia, 20.3 and 20.0%, respectively). Rates of dying at home among patients with residential socioeconomic scores of 1, 2-9, and 10 were about 15, 30, and 42.9%, respectively. In patients from the 4th to the 7th decades of life, rates of death at home increased at a linear rate that increased exponentially from the 8th decade onwards. After controlling for potential confounders, predictive variables for death at home included age (OR = 1.020 per year, 95% CI 1.017-1.024), male sex (OR = 1.18, 95% CI 1.077-1.294), years of education (OR = 1.029 per year, 95% CI 1.018-1.040), and time from diagnosis (OR = 1.003 per month, 95% CI 1.001-1.005 all p < 0.001). No trend was seen from 2008 to 2013, while from 2014 to 2017 a slight increase in the rate of death at home was seen each year.
These results indicate wide variability in death at home exists among patients of different ages, sex, education, socioeconomic status and time from diagnosis. These findings stress the importance of delivering quality palliative care at home, mainly for patients with hematologic malignancies, younger patients, and patients of very low socioeconomic status. Understanding the complex mechanisms whereby patient preferences and the above variables may determine the preferred place of death remains an important research priority.
大多数癌症患者更愿意在家中离世，但许多人最终还是在医院去世。本研究旨在阐明在以色列癌症患者人群中，在家中离世与各种个人因素之间的关联。
通过以色列中央统计局和以色列国家癌症登记处提供了癌症发病（2008-2015 年）和死亡（2008-2017 年）的数据。采用二元逻辑回归分析，在校正年龄、性别、种族、受教育年限、居住社会经济评分和诊断后时间等因素后，评估癌症诊断后在家中死亡的比值比。我们还评估了死亡地点与特定癌症部位之间的关系，以及 2008 年至 2017 年的时间趋势。
研究人群中约有四分之一（26.7%）的人在家中去世。在家中去世的患者中，脑肿瘤患者（37.0%）最多，而血液恶性肿瘤患者（淋巴瘤和白血病，分别为 20.3%和 20.0%）则最少。居住社会经济评分 1、2-9 和 10 的患者中，在家中去世的比例分别约为 15%、30%和 42.9%。在 40 岁至 70 岁的患者中，在家中去世的比例呈线性增加，从 80 岁开始呈指数级增加。在校正潜在混杂因素后，在家中去世的预测变量包括年龄（每年增加 1.020，95%CI 1.017-1.024）、男性（OR=1.18，95%CI 1.077-1.294）、受教育年限（每年增加 1.029，95%CI 1.018-1.040）和诊断后时间（每月增加 1.003，95%CI 1.001-1.005，均 p<0.001）。2008 年至 2013 年未见趋势，而 2014 年至 2017 年每年在家中去世的比例略有增加。
这些结果表明，不同年龄、性别、教育程度、社会经济地位和诊断后时间的患者在家中去世的情况存在很大差异。这些发现强调了在家庭中提供高质量姑息治疗的重要性，特别是针对血液恶性肿瘤患者、年轻患者和社会经济地位极低的患者。了解患者偏好和上述变量如何决定首选死亡地点的复杂机制仍然是一个重要的研究重点。
