Department of Public Health, University of Otago, Wellington, New Zealand.
Waitemata District Health Board, Auckland, New Zealand.
JCO Glob Oncol. 2022 May;8:e2200024. doi: 10.1200/GO.22.00024.
Around a third of people with cancer will die outside of their preferred place of death, with substantial variation occurring between and within countries in terms of place of death. Here, we examine place of death within the New Zealand cancer context, with specific focus on differences between Indigenous Māori and other ethnic groups.
Using national-level data, we identified all those who died in New Zealand between 2007 and 2018 of cancer (N = 107,373), stratified by ethnicity and cancer type, and linked these patients to national health and mortality records. We then described the crude and age-standardized proportions of cancer deaths by location separately by ethnic group, and conducted logistic regression to compare odds of death within a given location between ethnic groups.
After adjusting for age, sex, and deprivation, we found that Māori people with cancer are more likely to die in a private residence than Europeans (46% 26%; odds ratio [OR] 2.45; 95% CI, 2.36 to 2.55), and also somewhat more likely to die in hospital (27% 23%; OR 1.26; 95% CI, 1.21 to 1.32). Commensurately, Māori are less likely to die in either hospice inpatient unit (14% 27%; OR 0.48; 95% CI, 0.45 to 0.51) or residential care (12% 30%; OR 0.56; 95% CI, 0.52 to 0.59). Pacific patients generally follow the same pattern as Māori patients. These findings were largely repeated across cancer types, with some variation in the magnitude not overall pattern.
It remains unclear whether these differences reflect differences in preferences for place of death between ethnic groups, or whether they reflect differences in access to appropriate supportive care. Further research is required to examine these differences in greater detail.
大约三分之一的癌症患者会在他们首选的死亡地点之外死亡，而不同国家和国家内部在死亡地点方面存在着很大的差异。在这里，我们研究了新西兰癌症背景下的死亡地点，特别关注毛利族和其他族裔群体之间的差异。
使用国家级别的数据，我们确定了 2007 年至 2018 年期间在新西兰死于癌症的所有人（N=107373），按族裔和癌症类型进行分层，并将这些患者与国家卫生和死亡率记录相联系。然后，我们分别按族裔描述了按地点分类的癌症死亡的粗率和年龄标准化比例，并进行逻辑回归以比较不同族裔群体在特定地点死亡的几率。
在调整了年龄、性别和贫困程度后，我们发现毛利族癌症患者更有可能在私人住宅中死亡，而不是在欧洲人（46% 26%；优势比[OR]2.45；95%置信区间，2.36 至 2.55），而且在医院死亡的可能性也略高（27% 23%；OR 1.26；95%置信区间，1.21 至 1.32）。相应地，毛利族在临终关怀住院病房（14% 27%；OR 0.48；95%置信区间，0.45 至 0.51）或养老院（12% 30%；OR 0.56；95%置信区间，0.52 至 0.59）死亡的可能性较小。太平洋岛民患者的情况大致与毛利族患者相同。这些发现基本适用于所有癌症类型，但在总体模式下存在一些差异。
目前尚不清楚这些差异是反映了族裔群体对死亡地点的偏好不同，还是反映了获得适当支持性护理的机会不同。需要进一步研究以更详细地研究这些差异。
