Differences in place of death between lung cancer and COPD patients: a 14-country study using death certificate data
Differences in place of death between lung cancer and COPD patients: a 14-country study using death certificate data
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DOI：
10.1038/s41533-017-0017-y
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发表时间：
2017-03-03
影响因子：
3.1
通讯作者：
Houttekier, Dirk
中科院分区：
文献类型：
--
作者：
Cohen, Joachim;Beernaert, Kim;Houttekier, Dirk
慢性阻塞性肺疾病和肺癌是导致死亡的主要原因，在生命结束时症状相似。作为临终关怀的重要结果，慢性阻塞性肺疾病和肺癌死亡者的死亡地点的跨国比较以前没有研究过。我们收集了来自14个国家的人口死亡证明数据（年份：2008年），包括死亡地点、潜在死亡原因和人口统计信息。我们纳入了死于肺癌或慢性阻塞性肺病的患者，并使用描述性统计和多变量logistic回归来描述死亡模式。在5，568，827例死亡中，5.8%死于肺癌，4.4%死于慢性阻塞性肺病。在肺癌死亡者中，韩国的家庭死亡率为12.5%，墨西哥为57.1%，而新西兰的医院死亡率为27.5%，法国为77.4%。在慢性阻塞性肺疾病患者中，在家中死亡的比例从加拿大的10.4%到墨西哥的55.4%不等，而医院死亡率从墨西哥的41.8%到韩国的78.9%不等。在控制了年龄、性别和婚姻状况后，9个国家的慢性阻塞性肺疾病患者在家中死亡的可能性明显低于在医院死亡的可能性。我们的研究发现，在几乎所有国家，死于慢性阻塞性肺病的人与死于肺癌的人相比，在家中和姑息治疗机构死亡的可能性较小，而在医院或疗养院死亡的可能性较大。这可能是由于慢性阻塞性肺疾病的疾病轨迹和死亡预后的可预测性较低。
Chronic obstructive pulmonary disease and lung cancer are leading causes of death with comparable symptoms at the end of life. Cross-national comparisons of place of death, as an important outcome of terminal care, between people dying from chronic obstructive pulmonary disease and lung cancer have not been studied before. We collected population death certificate data from 14 countries (year: 2008), covering place of death, underlying cause of death, and demographic information. We included patients dying from lung cancer or chronic obstructive pulmonary disease and used descriptive statistics and multivariable logistic regressions to describe patterns in place of death. Of 5,568,827 deaths, 5.8% were from lung cancer and 4.4% from chronic obstructive pulmonary disease. Among lung cancer decedents, home deaths ranged from 12.5% in South Korea to 57.1% in Mexico, while hospital deaths ranged from 27.5% in New Zealand to 77.4% in France. In chronic obstructive pulmonary disease patients, the proportion dying at home ranged from 10.4% in Canada to 55.4% in Mexico, while hospital deaths ranged from 41.8% in Mexico to 78.9% in South Korea. Controlling for age, sex, and marital status, patients with chronic obstructive pulmonary disease were significantly less likely die at home rather than in hospital in nine countries. Our study found in almost all countries that those dying from chronic obstructive pulmonary disease as compared with those from lung cancer are less likely to die at home and at a palliative care institution and more likely to die in a hospital or a nursing home. This might be due to less predictable disease trajectories and prognosis of death in chronic obstructive pulmonary disease.