Vestergaard Anne Høy Seemann, Christiansen Christian Fynbo, Neergaard Mette Asbjoern, Valentin Jan Brink, Johnsen Søren Paaske
Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus N, 8200, Denmark.
Palliative Care Unit & Child and Youth Palliative Care Team, Oncology Department, Aarhus University Hospital, Aarhus N, 8200, Denmark.
Clin Epidemiol. 2022 May 4;14:653-664. doi: 10.2147/CLEP.S362170. eCollection 2022.
Socioeconomic disparities in end-of-life care have been reported across underlying diseases, but there is a paucity of information on potential time trends. Thus, we aimed to examine time trends in use of health-care services at the end of life according to socioeconomic position in patients dying from cancer and non-cancer diseases.
We conducted a nationwide registry-based study among adults dying from cancer or non-cancer diseases (diabetes, dementia, heart failure, ischemic heart disease, stroke, chronic liver disease, and chronic obstructive pulmonary disease) in Denmark in 2006-2016. We obtained data on patients' educational level and income level and use of health-care services within three months before death. Use of health-care services according to educational level and income level was plotted by calendar year of death and compared by regression analyses adjusting for age, sex, comorbidity, cohabitation, and municipality.
In both cancer (n = 169,694) and non-cancer patients (n = 180,350), we found limited socioeconomic disparities and no clear temporal trends in use of hospital, intensive care, emergency room, general practice, home care nurse, and hospice. In 2006/2007, one percentage point more cancer patients with high income level compared with low income level were affiliated with hospital-based specialist palliative care (adjusted mean difference: 0.01 (95% confidence interval (CI): 0.01; 0.02)), whereas this was 12 percentage points in 2016 (adjusted mean difference: 0.12 (95% CI: 0.09; 0.14)).
Socioeconomic disparities in specialist palliative care tended to increase over time among cancer patients but were limited and without clear time trends in use of other health-care services in both cancer and non-cancer patients.
已有研究报道了不同基础疾病患者在临终关怀方面存在社会经济差异，但关于潜在时间趋势的信息却很少。因此，我们旨在根据社会经济地位，研究癌症和非癌症疾病患者临终时医疗服务使用情况的时间趋势。
我们在丹麦进行了一项基于全国登记系统的研究，研究对象为2006年至2016年间死于癌症或非癌症疾病（糖尿病、痴呆症、心力衰竭、缺血性心脏病、中风、慢性肝病和慢性阻塞性肺疾病）的成年人。我们获取了患者的教育水平、收入水平以及死亡前三个月内医疗服务使用情况的数据。根据教育水平和收入水平绘制了按死亡年份划分的医疗服务使用情况图表，并通过对年龄、性别、合并症、同居情况和市政区域进行调整的回归分析进行比较。
在癌症患者（n = 169,694）和非癌症患者（n = 180,350）中，我们发现社会经济差异有限，且在医院、重症监护、急诊室、全科医疗、家庭护理和临终关怀服务的使用上没有明显的时间趋势。2006/2007年，高收入水平的癌症患者与低收入水平的癌症患者相比，接受医院专科姑息治疗的比例高1个百分点（调整后平均差异：0.01（95%置信区间（CI）：0.01；0.02）），而在2016年这一比例为12个百分点（调整后平均差异：0.12（95%CI：0.09；0.14））。
随着时间的推移，癌症患者在专科姑息治疗方面的社会经济差异趋于增加，但在癌症和非癌症患者中，其他医疗服务使用方面的差异有限且无明显时间趋势。
