Trajectories of Long-Term Care Expenditure During the Last 5?Years of Life in Japan: A Nationwide Retrospective Cohort Study
Trajectories of Long-Term Care Expenditure During the Last 5?Years of Life in Japan: A Nationwide Retrospective Cohort Study
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日本过去 5 年的长期护理支出轨迹：一项全国范围的回顾性队列研究
DOI：
10.1016/j.jamda.2021.01.084
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发表时间：
2021
影响因子：
7.6
通讯作者：
Tamiya Nanako
中科院分区：
文献类型：
--
作者：
Jin Xueying;Abe Kazuhiro;Taniguchi Yuta;Watanabe Taeko;Miyawaki Atsushi;Tamiya Nanako
尽管在生命结束时长期护理（LTC）服务的利用率很高，但关于LTC支出轨迹的证据很少。本研究旨在确定生命最后5年中LTC支出的不同轨迹，并检查这些轨迹是否因死亡原因而不同。设计一项基于国家LTC索赔和日本国家生命统计数据的全国回顾性纵向队列研究。设置和参与者包括70岁或以上的死者，死于2017年。方法我们评估了5年的每月长期护理支出的参与者和应用组为基础的轨迹模型，以确定不同的轨迹的长期护理支出。随后进行多项Logistic回归分析，以调查这些轨迹如何根据死因不同causeofdeath.ResultsAmong 1，124，335死者，4个不同的轨迹LTC支出确定：持续低（58.5%），后期增加（9.8%），逐步增加，然后后期减少（8.8%），和持续高（22.9%）。约80.7%的长期护理总支出是由持续高水平组花费的。调整后的年龄和性别，由于年龄相关的身体虚弱和痴呆症的死亡与持续高LTC expenditure.Conclusions and ImplicationsOngoing LTC政策和减少LTC支出的讨论时，强调持续高消费者可能会更有效。此外，在寿命结束时长期护理的预算分配应与健康状况数据相结合。
ObjectivesDespite the significant utilization of long-term care (LTC) services at the end of life, evidence on the trajectory of LTC expenditure in later life is scarce. This study aims to identify distinct trajectories of LTC expenditure in the last 5 years of life and to examine whether these trajectories differ according to cause of death.DesignA nationwide retrospective longitudinal cohort study based on linked data of National LTC Claims and the Japan's National Vital Statistic.Setting and ParticipantsParticipants comprised decedents aged 70 years or older and who died in 2017.MethodsWe assessed 5 years of monthly LTC expenditure among participants and applied group-based trajectory model to identify distinct trajectories of LTC expenditure. Subsequently multinominal logistic regression analysis was performed to investigate how these trajectories vary according to cause of death.ResultsAmong 1,124,335 decedents, 4 distinct trajectories of LTC expenditure were identified: persistently low (58.5%), late increase (9.8%), progressive increase then late decrease (8.8%), and persistently high (22.9%). Approximately 80.7% of total LTC expenditure was spent by the persistently high group. After adjustment for age and sex; deaths due to age-related physical debility and dementia were associated with persistently high LTC expenditure.Conclusions and ImplicationsOngoing discussions of LTC policy and reducing LTC expenditure may be more effective when emphasizing persistently high spenders. In addition, budget allocation for LTC at the end of life should be combined with data for health conditions.