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Risk factors for hospital death in conditions needing palliative care: Nationwide population-based death certificate study.
- Source :
-
Palliative Medicine . Apr2018, Vol. 32 Issue 4, p891-901. 11p. 4 Charts, 2 Graphs. - Publication Year :
- 2018
-
Abstract
- Background: Most people would prefer to die at home as opposed to hospital; therefore, understanding mortality patterns by place of death is essential for health resources allocation. Aim: We examined trends and risk factors for hospital death in conditions needing palliative care in a country without integrated palliative care. Design: This is a death certificate study. We examined factors associated with hospital death using logistic regression. Setting/participants: All adults (1,045,381) who died between 2003 and 2012 in Portugal were included. We identified conditions needing palliative care from main causes of death: cancer, heart/cerebrovascular, renal, liver, respiratory and neurodegenerative diseases, dementia/Alzheimer's/senility and HIV/AIDS. Results: Conditions needing palliative care were responsible for 70.7% deaths (N = 738,566, median age 80); heart and cerebrovascular diseases (43.9%) and cancer (32.2%) accounted for most. There was a trend towards hospital death (standardised percentage: 56.3% in 2003, 66.7% in 2012; adjusted odds ratio: 1.04, 95% confidence interval: 1.04-1.04). Hospital death risk was higher for those aged 18-39 years (3.46, 3.25-3.69 vs aged 90+), decreasing linearly with age; lower in dementia/Alzheimer's/senility versus cancer (0.13, 0.13-0.13); and higher for the married and in HIV/AIDS (3.31, 3.00-3.66). Effects of gender, working status, weekday and month of death, hospital beds availability, urbanisation level and deprivation were small. Conclusion: The upward hospital death trend and fact that being married are risk factors for hospital death suggest that a reliance on hospitals may coexist with a tradition of extended family support. The sustainability of this model needs to be assessed within the global transition pattern in where people die. [ABSTRACT FROM AUTHOR]
- Subjects :
- *CONFIDENCE intervals
*CAUSES of death
*EMPLOYMENT
*HEALTH services accessibility
*INTEGRATED health care delivery
*MEDICAL needs assessment
*NEURODEGENERATION
*PALLIATIVE treatment
*RESPIRATORY diseases
*SEX distribution
*TUMORS
*LOGISTIC regression analysis
*DEATH certificates
*HOSPITAL mortality
*ODDS ratio
*POPULATION-based case control
Subjects
Details
- Language :
- English
- ISSN :
- 02692163
- Volume :
- 32
- Issue :
- 4
- Database :
- Academic Search Index
- Journal :
- Palliative Medicine
- Publication Type :
- Academic Journal
- Accession number :
- 128758459
- Full Text :
- https://doi.org/10.1177/0269216317743961