Edinburgh Clinical Trials Unit, University of Edinburgh, United Kingdom.
Edinburgh Cancer Research Centre, University of Edinburgh, United Kingdom.
Int J Popul Data Sci. 2023 Jan 16;8(1):1768. doi: 10.23889/ijpds.v8i1.1768. eCollection 2023.
Approximately thirty thousand people in Scotland are diagnosed with cancer annually, of whom a third live less than one year. The timing, nature and value of hospital-based healthcare for patients with advanced cancer are not well understood. The study's aim was to describe the timing and nature of hospital-based healthcare use and associated costs in the last year of life for patients with a cancer diagnosis.
We undertook a Scottish population-wide administrative data linkage study of hospital-based healthcare use for individuals with a cancer diagnosis, who died aged 60 and over between 2012 and 2017. Hospital admissions and length of stay (LOS), as well as the number and nature of outpatient and day case appointments were analysed. Generalised linear models were used to adjust costs for age, gender, socioeconomic deprivation status, rural-urban (RU) status and comorbidity.
The study included 85,732 decedents with a cancer diagnosis. For 64,553 (75.3%) of them, cancer was the primary cause of death. Mean age at death was 80.01 (SD 8.15) years. The mean number of inpatient stays in the last year of life was 5.88 (SD 5.68), with a mean LOS of 7 days. Admission rates rose sharply in the last month of life. One year adjusted and unadjusted costs decreased with increasing age. A higher comorbidity burden was associated with higher costs. Major cost differences were present between cancer types.
People in Scotland in their last year of life with cancer are high users of secondary care. Hospitalisation accounts for a high proportion of costs, particularly in the last month of life. Further research is needed to examine triggers for hospitalisations and to identify influenceable reasons for unwarranted variation in hospital use among different cancer cohorts.
苏格兰每年约有 3 万人被诊断患有癌症，其中三分之一的人活不到一年。对于晚期癌症患者，医院为其提供的医疗保健的时间、性质和价值尚未得到充分理解。本研究旨在描述癌症患者临终前一年内的医院医疗保健使用情况及相关费用的时间和性质。
我们对苏格兰全人群的癌症患者进行了一项基于行政数据的医疗保健使用情况的关联性研究，这些患者在 2012 年至 2017 年间年龄均超过 60 岁且已死亡。我们分析了住院次数和住院时间（LOS），以及门诊和日间手术预约次数和性质。使用广义线性模型来调整年龄、性别、社会经济贫困状况、城乡（RU）状况和合并症对成本的影响。
本研究纳入了 85732 名有癌症诊断记录的死者。其中 64553 人（75.3%）的主要死因是癌症。死亡时的平均年龄为 80.01 岁（SD 8.15 岁）。临终前一年的平均住院次数为 5.88 次（SD 5.68 次），平均 LOS 为 7 天。入院率在生命的最后一个月急剧上升。调整后的和未经调整的 1 年成本随年龄的增加而降低。合并症负担越重，成本越高。不同癌症类型之间存在较大的成本差异。
苏格兰临终前一年的癌症患者是二级保健的高使用者。住院治疗占费用的很大一部分，特别是在生命的最后一个月。需要进一步研究以探讨住院的触发因素，并确定不同癌症队列之间不合理的住院使用差异的可影响原因。
