Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
Department of Clinical Medicine, Aarhus University, Aarhus C, Denmark.
BMJ Open. 2021 Nov 24;11(11):e049661. doi: 10.1136/bmjopen-2021-049661.
To investigate illness trajectories as reflected by healthcare utilisation, including hospital and intensive care unit admissions, consultations in general practice and home care provision, before death comparing people dying from chronic obstructive pulmonary disease (COPD), heart failure and cancer.
Nationwide register-based cohort study.
Data on all hospital admissions, including intensive care unit admissions, consultations in general practice and home care provision were obtained from nationwide Danish registries.
All adult decedents in Denmark dying from COPD, heart failure or cancer between 2006 and 2016.
For each day within 5 years before death, we computed a daily prevalence proportion (PP) of being admitted to hospital or consulting a general practitioner. For each day within 6 months before death, we computed PPs of being admitted to intensive care or receiving home care. The PPs were plotted and compared by regression analyses adjusting for age, gender, comorbidity level, marital/cohabitation status, municipality and income level.
Among 1 74 086 patients dying from COPD (n=22 648), heart failure (n=11 498) or cancer (n=139 940), the PPs of being admitted to hospital or consulting a general practitioner showed similar steady progression and steep increase in the last year of life for all patient populations. The PP of being admitted to intensive care showed modest increase during the last 6 months of life, accelerating in the last month, for all patient populations. For patients with COPD and heart failure, the PP of receiving home care remained stable during the last 6 months of life but increased steadily for patients with cancer.
We found limited differences in healthcare resource utilisation at the end of life for people with COPD, heart failure or cancer, indicating comparable illness trajectories.This supports the need to reconsider efforts in achieving equal access to palliative care interventions, which is still mainly offered to patients with cancer.
通过比较慢性阻塞性肺疾病（COPD）、心力衰竭和癌症患者的医疗保健利用情况（包括住院和重症监护病房入院、全科医生就诊和家庭护理），来探讨疾病轨迹。
全国范围内基于注册的队列研究。
所有住院、包括重症监护病房入院、全科医生就诊和家庭护理的数据均来自全国性的丹麦登记处。
2006 年至 2016 年期间，丹麦所有死于 COPD、心力衰竭或癌症的成年死者。
在死亡前 5 年内的每一天，我们计算了住院或看全科医生的每日流行率（PP）。在死亡前 6 个月的每一天，我们计算了进入重症监护病房或接受家庭护理的 PP。通过回归分析调整年龄、性别、合并症水平、婚姻/同居状况、市和收入水平后，绘制并比较了这些 PP。
在 174086 名死于 COPD（n=22648）、心力衰竭（n=11498）或癌症（n=139940）的患者中，所有患者群体在生命的最后一年，住院或看全科医生的 PP 呈相似的稳定进展和急剧增加。所有患者群体在生命的最后 6 个月，进入重症监护病房的 PP 呈适度增加，在最后一个月加速。对于 COPD 和心力衰竭患者，生命的最后 6 个月家庭护理的 PP 保持稳定，但对于癌症患者，PP 则稳步增加。
我们发现 COPD、心力衰竭和癌症患者在生命末期的医疗资源利用情况存在有限差异，表明疾病轨迹相似。这支持需要重新考虑努力实现平等获得姑息治疗干预的机会，而姑息治疗干预目前主要提供给癌症患者。
