Where people die - A multilevel approach to understanding influences on site of death in America
Where people die - A multilevel approach to understanding influences on site of death in America
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DOI：
10.1177/1077558707301810
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发表时间：
2007-08-01
影响因子：
2.5
通讯作者：
Roy, Jason
中科院分区：
文献类型：
--
作者：
Gruneir, Andrea;Mor, Vincent;Roy, Jason
尽管有文献记载的偏好在家中死亡，但大多数死于绝症的人都发生在医院。为了更好地了解死亡的变化，我们进行了系统的文献综述和多层次分析，其中我们将死亡证明与县和州的数据联系起来。这两个组成部分的结果显示，在某些美国群体中，家庭死亡的机会不成比例;更具体地说，那些白色，有更多的资源和社会支持，死于癌症。从多水平分析，少数民族的比例越高，受教育程度越低，医院死亡的概率越高，而机构长期护理的投资，衡量地区密度的养老院床位和国家医疗补助支付率，与养老院死亡的概率较高。这些结果强化了社会和结构特征在塑造生命终结体验方面的重要性。
Despite documented preferences for home death, the majority of deaths from terminal illness occur in hospital. To better understand variation in place of death, we conducted a systematic literature review and a multilevel analysis in which we linked death certificates with county and state data. The results of both components revealed that opportunities for home death are disproportionately found in certain groups of Americans; more specifically, those who are White, have greater access to resources and social support, and die of cancer. From the multilevel analysis, the higher the proportion minority and the lower the level of educational attainment, the higher the probability of hospital death while investment in institutional long-term care, measured by regional density of nursing home beds and state Medicaid payment rate, was associated with higher probability of nursing home death. These results reinforce the importance of both social and structural characteristics in shaping the end-of-life experience.