How many people will need palliative care in 2040? Past trends, future projections and implications for services
How many people will need palliative care in 2040? Past trends, future projections and implications for services
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DOI：
10.1186/s12916-017-0860-2
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发表时间：
2017-05-18
期刊：
影响因子：
9.3
通讯作者：
Murtagh, F. E. M.
中科院分区：
文献类型：
--
作者：
Etkind, S. N.;Bone, A. E.;Murtagh, F. E. M.
背景：目前的估计表明，大约75%的人接近生命的尽头可能会受益于姑息治疗。在许多国家，老年人人数不断增加，慢性病发病率不断上升，这意味着今后可能会有更多的人受益于姑息治疗，但这一点尚未量化。本研究的目的是估计未来人口姑息治疗需要在两个高收入countries.Methods：我们使用的死亡率统计英格兰和威尔士从2006年至2014年。基于以前的诊断方法，我们计算了特定年龄和性别的慢性进展性疾病死亡比例，以估计人群中姑息治疗需求的流行程度。我们计算了9年期间的年度变化。使用关于疾病患病率随时间变化的明确假设和官方死亡率预测，我们模拟了到2040年的姑息治疗需求。我们还对痴呆症、癌症和器官衰竭进行了单独的预测。结果：到2040年，英格兰和威尔士的年死亡人数预计将上升25.4%（从2014年的501,424人上升到628,659人）。如果需要姑息治疗的年龄和性别比例与2014年相同，需要姑息治疗的人数将增加25.0%（从375，398人/年增加到469，305人/年）。然而，如果2006年至2014年观察到的上升趋势继续下去，增长率将达到42.4%（每年增加161，842人，共计537，240人）。此外，针对特定疾病的预测显示，（到2040年，每年死亡人数从59，199人增加到219，409人）和癌症（到2040年死亡人数从143，638人增加到208，636人）将是需求增加的主要驱动因素。如果最近的死亡率趋势继续下去，到2040年，英格兰和威尔士将有16万人需要姑息治疗。医疗保健系统现在必须开始适应与年龄相关的慢性病死亡增长，重点是整合和促进整个卫生和社会护理学科的姑息治疗。人口和疾病变化相似的国家可能会经历类似的需求增加。
Background: Current estimates suggest that approximately 75% of people approaching the end-of-life may benefit from palliative care. The growing numbers of older people and increasing prevalence of chronic illness in many countries mean that more people may benefit from palliative care in the future, but this has not been quantified. The present study aims to estimate future population palliative care need in two high-income countries.Methods: We used mortality statistics for England and Wales from 2006 to 2014. Building on previous diagnosis-based approaches, we calculated age-and sex-specific proportions of deaths from defined chronic progressive illnesses to estimate the prevalence of palliative care need in the population. We calculated annual change over the 9-year period. Using explicit assumptions about change in disease prevalence over time, and official mortality forecasts, we modelled palliative care need up to 2040. We also undertook separate projections for dementia, cancer and organ failure.Results: By 2040, annual deaths in England and Wales are projected to rise by 25.4% (from 501,424 in 2014 to 628,659). If age-and sex-specific proportions with palliative care needs remain the same as in 2014, the number of people requiring palliative care will grow by 25.0% (from 375,398 to 469,305 people/year). However, if the upward trend observed from 2006 to 2014 continues, the increase will be of 42.4% (161,842 more people/year, total 537,240). In addition, disease-specific projections show that dementia (increase from 59,199 to 219,409 deaths/year by 2040) and cancer (increase from 143,638 to 208,636 deaths by 2040) will be the main drivers of increased need.Conclusions: If recent mortality trends continue, 160,000 more people in England and Wales will need palliative care by 2040. Healthcare systems must now start to adapt to the age-related growth in deaths from chronic illness, by focusing on integration and boosting of palliative care across health and social care disciplines. Countries with similar demographic and disease changes will likely experience comparable rises in need.