The health impact of health care on families: a matched cohort study of hospice use by decedents and mortality outcomes in surviving, widowed spouses
The health impact of health care on families: a matched cohort study of hospice use by decedents and mortality outcomes in surviving, widowed spouses
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DOI：
10.1016/s0277-9536(02)00370-2
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发表时间：
2003-08-01
影响因子：
5.4
通讯作者：
Iwashyna, TJ
中科院分区：
文献类型：
--
作者：
Christakis, NA;Iwashyna, TJ
照顾重病患者的替代方法可能不仅对患者自身的结果产生影响，而且间接影响其家庭成员的健康结果。临床观察表明，“善终”的患者可能会给配偶带来更少的压力。因此，我们试图评估死者使用临终关怀是否与幸存的丧亲配偶的死亡风险降低有关。我们进行了一项匹配的回顾性队列研究，涉及美国195，553对老年夫妇的人群样本。共有30,838对夫妇的死者使用临终关怀匹配使用倾向评分法，30,838对夫妇的死者没有使用临终关怀。我们感兴趣的主要结果是丧偶者的生存时间。在调整其他测量变量后，5.4%的丧偶妻子在丈夫去世后18个月内死亡，当时他们的已故丈夫没有使用临终关怀，4.9%的妻子在他们的已故丈夫使用临终关怀时死亡，产生的优势比（OR）为0.92（95%CI：0.84-0.99），有利于临终关怀的使用。同样，13.7%的丧偶丈夫在18个月内死亡时，他们的已故妻子没有使用临终关怀，13.2%的死亡时，他们的已故妻子确实使用临终关怀，产生的OR为0.95（95%CI：0.84-1.06），有利于临终关怀的使用。我们的研究结果表明，临终关怀作为一种特别支持性的临终关怀，可能对死于疾病的患者的配偶产生有益的影响。临终关怀可能会降低通常与丧偶有关的死亡率。这种影响在男性和女性身上都存在，但在统计学上是显著的，而且可能在丧夫之妻身上更大。这种效应的大小与女性中各种其他可改变的风险因素中的死亡风险降低相当。保健可能具有积极的、群体一级的健康“外部性”：它可能不仅影响病人的健康，而且影响病人家属的健康。(C)2003爱思唯尔科技有限公司版权所有。
Alternative ways of caring for seriously ill patients might have implications not only for patients' own outcomes, but also, indirectly, for the health outcomes of their family members. Clinical observation suggests that patients who die "good deaths" may impose less stress on their spouses. Consequently, we sought to assess whether hospice use by a decedent is associated with decreased risk of death in surviving, bereaved spouses. We conducted a matched retrospective cohort study involving a population-based sample of 195,553 elderly couples in the USA. A total of 30,838 couples where the decedent used hospice care were matched using the propensity score method to 30,838 couples where the decedent did not use hospice care. Our principal outcome of interest was the duration of survival of bereaved widow/ers. After adjustment for other measured variables, 5.4% of bereaved wives died by 18 months after the death of their husband when their deceased husband did not use hospice and 4.9% died when their deceased husband did use hospice, yielding an odds ratio (OR) of 0.92 (95% CI: 0.84-0.99) in favor of hospice use. Similarly, whereas 13.7% of bereaved husbands died by 18 months when their deceased wife did not use hospice, 13.2% died when their deceased wife did use hospice, yielding an OR of 0.95 (95% CI: 0.84-1.06) in favor of hospice use. Our findings suggest a possible beneficial impact of hospice-as a particularly supportive type of end-of-life care-on the spouses of patients who succumb to their disease. Hospice care might attenuate the ordinarily increased mortality associated with becoming widowed. This effect is present in both men and women, but it is statistically significant and possibly larger in bereaved wives. The size of this effect is comparable to the reductions in the risk of death seen in a variety of other modifiable risk factors in women. Health care may have positive, group-level health "externalities": it may affect the health not only of patients but also of patients' family members. (C) 2003 Elsevier Science Ltd. All rights reserved.