The Ottawa Hospital, Division of Neurology, Ottawa, ON, Canada.
The University of Ottawa, Ottawa, ON, Canada.
J Parkinsons Dis. 2022;12(7):2249-2259. doi: 10.3233/JPD-223429.
The end-of-life period is associated with disproportionately higher health care utilization and cost at the population level but there is little data in Parkinson's disease (PD).
The goals of this study were to 1) compare health care use and associated cost in the last year of life between decedents with and without PD, and 2) identify factors associated with palliative care consultation and death in hospital.
Using linked administrative datasets held at ICES, we conducted a retrospective, population-based cohort study of all Ontario, Canada decedents from 2015 to 2017. We examined demographic data, rate of utilization across healthcare sectors, and cost of health care services in the last year of life.
We identified 291,276 decedents of whom 12,440 (4.3%) had a diagnosis of PD. Compared to decedents without PD, decedents with PD were more likely to be admitted to long-term care (52% vs. 23%, p < 0.001) and received more home care (69.0 vs. 41.8 days, p < 0.001). Receipt of palliative homecare or physician palliative home consultation were associated with lower odds of dying in hospital (OR: 0.24, 95% CI: 0.19- 0.30, and OR: 0.38, 95% CI: 0.33- 0.43, respectively). Mean cost of care in the last year of life was greater for decedents with PD ($68,391 vs. $59,244, p < 0.001).
Compared to individuals without PD, individuals with PD have higher rates of long-term care, home care and higher health care costs in the last year of life. Palliative care is associated with a lower rate of hospital death.
在人群层面上，生命末期与不成比例地更高的医疗保健利用和成本相关，但在帕金森病（PD）中数据很少。
本研究的目的是 1）比较有和没有 PD 的死者在生命的最后一年的医疗保健利用和相关成本，2）确定与姑息治疗咨询和医院死亡相关的因素。
使用 ICES 持有的链接行政数据集，我们对 2015 年至 2017 年期间所有安大略省加拿大死者进行了回顾性、基于人群的队列研究。我们检查了人口统计学数据、各医疗保健部门的利用率以及生命最后一年的医疗保健服务成本。
我们确定了 291276 名死者，其中 12440 人（4.3%）被诊断为 PD。与没有 PD 的死者相比，PD 死者更有可能入住长期护理机构（52%比 23%，p<0.001）和接受更多的家庭护理（69.0 比 41.8 天，p<0.001）。接受姑息性家庭护理或医生姑息性家庭咨询与更低的医院死亡几率相关（OR：0.24，95%CI：0.19-0.30，和 OR：0.38，95%CI：0.33-0.43）。生命最后一年的护理费用均值更高PD 死者（68391 美元比 59244 美元，p<0.001）。
与没有 PD 的个体相比，PD 个体在生命的最后一年有更高的长期护理、家庭护理和更高的医疗保健费用的比率。姑息治疗与更低的医院死亡率相关。
