Marie Curie, One Embassy Gardens, 8 Viaduct Gardens, London, SW11 7BW, UK.
Clinical Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, EH8 9AG, UK.
BMC Palliat Care. 2024 Nov 25;23(1):271. doi: 10.1186/s12904-024-01574-5.
Existing estimates of palliative care need in the UK were produced before the COVID-19 pandemic. We sought to produce updated, population-level estimates of palliative care need for each of the four UK nations and explore how these changed during the pandemic.
We conducted a descriptive analysis of routine data. We used a well-established, diagnosis-based methodology which produced minimal estimates of palliative care need based on underlying causes of death; intermediate estimates based on underlying and contributory causes of death; and maximal estimates based on excluding unexpected causes of death. Additional estimates incorporated deaths involving COVID-19. All methods were applied to official mortality statistics from England, Wales, Scotland, and Northern Ireland for the years 2017 to 2021.
From 2017 to 2019 for the UK in total, palliative care need was estimated at ~ 74% (minimal), ~ 90% (intermediate) and ~ 96% (maximal) of total deaths, which was broadly consistent with previous studies. Results were similar across all nations. In the pandemic years, 2020-21, the minimal estimates remained stable in terms of the number of people in need but dropped significantly in terms of the proportion of deaths associated with palliative care need (to ~ 66%) due to the overall increase in mortality and large number of deaths from COVID-19. The intermediate (~ 90%) and maximal (~ 96%) estimates showed an increase in the number of people in need but remained stable in proportion of deaths. When deaths involving COVID-19 were treated as deaths associated with palliative need, the minimal estimates increased to ~ 77% and intermediate estimates increased to ~ 92%.
In each of the UK's nations, most people who die will have palliative care needs. Excluding deaths from COVID-19 in population-level estimates of palliative care need risks under-estimating true levels of need. Future studies which estimate population-level palliative care need should consider factoring in deaths from COVID-19.
现有的英国姑息治疗需求估计是在 COVID-19 大流行之前得出的。我们试图为英国的四个国家中的每一个提供更新的、基于人群的姑息治疗需求估计，并探讨这些估计在大流行期间是如何变化的。
我们对常规数据进行了描述性分析。我们使用了一种经过充分验证的、基于根本死因的诊断方法，该方法根据根本死因产生了姑息治疗需求的最小估计值；根据根本死因和促成死因的中间估计值；以及排除意外死因的最大估计值。其他估计值包括涉及 COVID-19 的死亡。所有方法都应用于英格兰、威尔士、苏格兰和北爱尔兰 2017 年至 2021 年的官方死亡率统计数据。
2017 年至 2019 年，英国总体上的姑息治疗需求估计为74%（最小）、90%（中间）和96%（最大）的总死亡人数，这与之前的研究大致一致。所有国家的结果都相似。在大流行年份，2020-21 年，由于总体死亡率的增加和大量 COVID-19 死亡，最小估计值在需要人数方面保持稳定，但在与姑息治疗需求相关的死亡比例方面显著下降（降至66%）。中间（90%）和最大（96%）估计值显示需要人数增加，但死亡比例保持稳定。当涉及 COVID-19 的死亡被视为与姑息治疗需求相关的死亡时，最小估计值增加到77%，中间估计值增加到92%。
在英国的每个国家，大多数死亡的人都有姑息治疗需求。在姑息治疗需求的人群水平估计中排除 COVID-19 死亡可能会低估真实的需求水平。未来估计人群水平姑息治疗需求的研究应考虑将 COVID-19 死亡纳入其中。
