Disparities in specialist palliative care for Taiwanese children and young adults impacted by local digital development and noncancer diagnoses.

Abstract

Background: Disparities in specialist palliative care (SPC) are complex. Families of children and young adults with life-limiting conditions in digitally advanced areas have better access to health information and services.

Objectives: To examine SPC and end-of-life care for these patients, focusing on SPC referral rates and associated disparities.

Methods: A retrospective study used national health insurance data in Taiwan. Patients aged 1-25 years who died with life-limiting conditions between 2009 and 2017 were included in this study (n = 6863). The main focus was on referrals to SPC, identified through service codes for palliative shared care, home care, and inpatient hospice.

Results: A total of 979 patients (14.3%) received SPC at least 3 days before death. Cancer patients were over 10 times more likely to receive SPC than noncancer patients, with an odds ratio of 10.77 (95% confidence interval [CI]: 9.08-12.77). Conversely, patients with congenital, hematological, neurological, or respiratory conditions were over 60% less likely to receive SPC than those without such conditions. Patients in well-digitally developed townships had higher SPC referrals rates (adjusted odds ratio [aOR]: 1.28; 95% CI: 1.11-1.48). SPC was associated with longer hospital stays in the last month of life (aOR: 2.64; 95% CI: 2.28-3.06) and increased hospital deaths (aOR: 8.36; 95% CI: 5.66-12.35), but less likely to be admitted to hospitals in the last 5 days of life (aOR: 0.61; 95% CI: 0.50-0.74).

Conclusions: Few patients in Taiwan received SPC, highlighting that diagnosis is a significant predictor. This suggests a need for further investigation into resources for SPC.