Division of General Medicine, Department of Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, South Africa.
S Afr Med J. 2021 Nov 5;111(11):1070-1073. doi: 10.7196/SAMJ.2021.v111i11.15869.
Globally there is increasing awareness of the need for end-of-life care and palliative care in hospitalised patients who are in their final year of life. Limited data are available on palliative care requirements in low- and middle-income countries, hindering the design and implementation of effective policies and health services for these patients.
To determine the proportion of patients who die within 1 year of their date of admission to public hospitals in South Africa (SA), as a proxy for palliative care need in SA.
This was a retrospective cohort study using record linkage of admission and mortality data. The setting was 46 acute-care public hospitals in Western Cape Province, SA.
Of 10 761 patients (median (interquartile range (IQR)) age 44 (31 - 60) years) admitted to the 46 hospitals over a 2-week period in March 2012, 1 570 (14.6%) died within 1 year, the majority within the first 3 months. Mortality rose steeply with age. The median (IQR) age of death was 57.5 (45 - 70) years. A greater proportion of patients admitted to medical beds died within 1 year (21.3%) compared with those admitted to surgical beds (7.7%).
Despite a median age <60 years at admission, a substantial percentage of patients admitted to public sector hospitals in SA are in the final year of their lives. This finding should be seen in the context of SA's high communicable and non-communicable disease burden and resource-limited public health system, and highlights the need for policy development, planning and implementation of end-of-life and palliative care strategies for hospitals and patients.
全球范围内，人们越来越意识到临终关怀和姑息治疗在终末期住院患者中的重要性。然而，关于中低收入国家姑息治疗需求的数据有限，这阻碍了为这些患者设计和实施有效政策和卫生服务。
确定南非公立医院住院患者在入院后 1 年内死亡的比例，以此作为南非姑息治疗需求的指标。
这是一项回顾性队列研究，使用入院和死亡率数据的记录链接。研究地点为南非西开普省 46 家急性护理公立医院。
在 2012 年 3 月为期两周的时间内，10761 名（中位数（四分位距（IQR））年龄为 44（31-60）岁）患者入住了 46 家医院，其中 1570 名（14.6%）在 1 年内死亡，大多数死亡发生在入院后 3 个月内。死亡率随年龄急剧上升。死亡患者的中位数（IQR）年龄为 57.5（45-70）岁。与外科病床相比，内科病床的患者在入院后 1 年内死亡的比例更高（21.3%比 7.7%）。
尽管南非患者入院时的中位年龄<60 岁，但在南非公立医院住院的患者中，相当一部分患者处于生命的最后一年。这一发现应结合南非高传染性和非传染性疾病负担以及资源有限的公共卫生系统来看待，这突显了制定政策、规划和实施医院和患者临终关怀和姑息治疗策略的必要性。
