Hanson L C, Rodgman E
Division of General Medicine, University of North Carolina, Chapel Hill, USA.
Arch Intern Med. 1996 May 13;156(9):1018-22.
Knowing more about who uses living wills may help explain their limited acceptance.
We analyzed the 1986 National Mortality Followback Survey, a random sample of all US deaths linked to a survey about decedents' use of living wills, their social and health status, and their use of medical services. Decedents with and without living wills were compared for differences in social and health characteristics and use of medical services.
There were 16,678 decedents; 9.8% had a living will. Rates of use were higher for decedents who were white (10.7%), were female (11.0%), had private insurance (13.8%), had incomes of $22,000 or more (14.5%), or had college educations (18.7%). The use of living wills was lower among blacks (2.7%), Medicaid recipients (6.3%), those with incomes of less than $5,000 (7.5%), or those with less than 8 years of education (4.0%). Health was also related to use of living wills. Functionally independent persons were unlikely to have a living will (5.5%); use increased with dependency. Cognitive impairment made it less likely that a decedent had a living will (6.7%). Persons who died of cancer (16.4%) or pulmonary disease (11.4%) were more likely to have one. All demographic and health characteristics remained significant in multivariate analyses. Controlling for health status, decedents with living wills used more physician visits (five to nine vs two to four, P < .001) and hospital days (37 vs 30, P < .001). Although more likely to use hospices (19.5% vs 8.4%, P < .001) and half as likely to receive cardiopulmonary resuscitation or ventilatory support, they were still 20% more likely to die in the hospital.
Patients who are black, poorly educated, underinsured, or cognitively impaired are least likely to prepare a living will. Decedents with living wills forgo specific treatments, but remain intensive users of routine medical services.
更多地了解使用生前预嘱的人群，可能有助于解释其接受程度有限的原因。
我们分析了1986年全国死亡率随访调查，该调查是对所有美国死亡病例的随机抽样，并与一项关于死者生前预嘱的使用情况、社会和健康状况以及医疗服务使用情况的调查相关联。比较了有生前预嘱和没有生前预嘱的死者在社会和健康特征以及医疗服务使用方面的差异。
共有16,678名死者；9.8%的人有生前预嘱。白人死者（10.7%）、女性死者（11.0%）、有私人保险的死者（13.8%）、收入在22,000美元或以上的死者（14.5%）或受过大学教育的死者（18.7%）的生前预嘱使用率较高。黑人死者（2.7%）、医疗补助接受者（6.3%）、收入低于5,000美元的死者（7.5%）或受教育年限少于8年的死者（4.0%）的生前预嘱使用率较低。健康状况也与生前预嘱的使用有关。功能独立的人不太可能有生前预嘱（5.5%）；随着依赖程度的增加，使用率上升。认知障碍使死者拥有生前预嘱的可能性降低（6.7%）。死于癌症（16.4%）或肺部疾病（11.4%）的人更有可能有生前预嘱。在多变量分析中，所有人口统计学和健康特征仍然具有显著性。在控制健康状况后，有生前预嘱的死者看医生的次数更多（5至9次对2至4次，P < .001），住院天数更多（37天对30天，P < .001）。尽管他们更有可能使用临终关怀服务（19.5%对8.4%，P < .00,1），接受心肺复苏或通气支持的可能性只有一半，但他们在医院死亡的可能性仍然高出20%。
黑人、受教育程度低、保险不足或有认知障碍的患者最不可能制定生前预嘱。有生前预嘱的死者会放弃特定治疗，但仍然是常规医疗服务的密集使用者。
