Chen Huiting, Fan Yibing, Wu Hao, Cao Yu, Zeng Fanyan, Liu Hui, Gao Wei
School of Public Health, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China.
Jiangxi Provincial Key Laboratory of Disease Prevention and Public Health, Nanchang University, Nanchang, 330006, China.
Sci Rep. 2025 May 2;15(1):15430. doi: 10.1038/s41598-025-98589-6.
Little is known about the place of death at the regional level in China. Furthermore, the impact of COVID-19 on the place of death remains unclear. We aimed to examine the place of death before and during COVID-19 in Nanchang, China, focusing on changes in home death across different causes, to determine whether these changes were disproportionately experienced among patients with different diseases. Using data from the National Death Registration System, Nanchang, China, this population-based, observational study examined all non-accidental deaths from 1 January 2014 to 31 December 2019 (pre-COVID-19), and 25 January 2020 to 31 December 2022 (during COVID-19). Modified Poisson regression models were employed to assess the association between underlying cause of death and home death, and interaction terms added to evaluate changes over periods. We used R version 4.2.2 for all analyses. The analysis included 198,383 deaths, with a median age of 78 years (IQR: 66-85); 58.2% were male and 41.8% were female. Home deaths rose from 72.7% pre-COVID-19 to 75.6% during COVID-19 (p < 0.0007). Before COVID-19, patients with renal failure (adjusted PR 0.74 [95% CI, 0.67-0.81]), liver disease (0.81 [0.76-0.86]), and hematological cancer (0.88 [0.84-0.92]) were less likely to die at home compared to those with solid cancer. During COVID-19, these disparities diminished, with a significant increase in home deaths among renal failure (1.32 [1.19-1.48]), liver disease (1.19 [1.10-1.29]), and hematological cancer (1.12 [1.05-1.20]). The majority of non-accidental deaths occurred at home, with a notable rise during COVID-19, underscoring the urgent need to strengthen community- and home-based end-of-life care services. Although home death rates for patients with renal failure, liver disease, and hematological cancer were lower before COVID-19, they increased significantly during the pandemic, highlighting disparities in end-of-life care that necessitate targeted improvements.
在中国，关于地区层面的死亡地点知之甚少。此外，新冠疫情对死亡地点的影响仍不明确。我们旨在研究中国南昌在新冠疫情之前和期间的死亡地点，重点关注不同病因导致的在家死亡情况的变化，以确定这些变化在不同疾病患者中是否存在不均衡现象。本基于人群的观察性研究利用了中国南昌国家死亡登记系统的数据，调查了2014年1月1日至2019年12月31日（新冠疫情之前）以及2020年1月25日至2022年12月31日（新冠疫情期间）所有非意外死亡情况。采用修正泊松回归模型评估死亡根本原因与在家死亡之间的关联，并添加交互项以评估不同时期的变化。所有分析均使用R 4.2.2版本。该分析纳入了198,383例死亡病例，中位年龄为78岁（四分位间距：66 - 85岁）；男性占58.2%，女性占41.8%。在家死亡比例从新冠疫情之前的72.7%升至疫情期间的75.6%（p < 0.0007）。在新冠疫情之前，与实体癌患者相比，肾衰竭患者（调整后PR 0.74 [95%CI，0.67 - 0.81]）、肝病患者（0.81 [0.76 - 0.86]）和血液系统癌症患者（0.88 [0.84 - 0.92]）在家死亡的可能性较小。在新冠疫情期间，这些差异缩小，肾衰竭患者（1.32 [1.19 - 1.48]）、肝病患者（1.19 [1.10 - 1.29]）和血液系统癌症患者（1.12 [1.05 - 1.20]）的在家死亡人数显著增加。大多数非意外死亡发生在家中，在新冠疫情期间显著上升，这凸显了加强社区和家庭临终关怀服务的迫切需求。尽管肾衰竭、肝病和血液系统癌症患者在新冠疫情之前的在家死亡率较低，但在疫情期间显著上升，这突出了临终关怀方面的差异，需要针对性地加以改善。
