End-of-life care for inpatients with schizophrenia: national claims database retrospective cohort study.

IF 2 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

BMJ Supportive & Palliative Care Pub Date : 2025-07-15 DOI:10.1136/spcare-2025-005474

Fumiya Ito, Shintaro Togashi, Maho Aoyama, Masaki Fujiwara, Norika Mitsunaga, Natsuko Kobayashi, Mitsunori Miyashita

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Abstract

Aim: This study aimed to clarify the end-of-life care among inpatients with schizophrenia, using a national claims database.

Methods: We conducted a retrospective cohort study of inpatients aged 20 years and older who died between 2012 and 2015, using a sampling dataset of the National Database (NDB) of Japan. The outcome was the proportion of patients who received end-of-life care in the last 14 days of life.

Results: We analysed data from 49 932 end-of-life patients, 530 of whom had schizophrenia. Regarding the place of death, patients with schizophrenia died in psychiatric units (44.8% (95% CI 41.7 to 48.9)). A lower proportion of patients with schizophrenia received cardiopulmonary resuscitation (CPR) (16.6% vs 20.5%, p<0.001) or mechanical ventilation (13.4% vs 20.9%, p<0.001), but they were more likely to receive opioids (20.8% vs 19.0%, p=0.30) compared with those without schizophrenia. Multivariate logistic regression analysis showed that schizophrenia was negatively associated with receiving CPR (adj OR: 0.50 (95% CI 0.38 to 0.65), p<0.001) and mechanical ventilation (adj OR: 0.48 (95% CI 0.36 to 0.63), p<0.001), but positively associated with receiving opioids (adj OR: 1.57 (95% CI 1.18 to 2.09), p=0.002).

Conclusion: This study revealed the place of death and the provision of high-intensity end-of-life care for inpatients with schizophrenia, utilising the NDB of Japan.

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住院精神分裂症患者的临终关怀：国家索赔数据库回顾性队列研究。

目的：本研究旨在利用国家索赔数据库，阐明精神分裂症住院患者的临终关怀。方法：采用日本国家数据库（NDB）的抽样数据，对2012 - 2015年间死亡的20岁及以上住院患者进行回顾性队列研究。结果是在生命的最后14天内接受临终关怀的患者比例。结果：我们分析了49932名临终患者的数据，其中530人患有精神分裂症。至于死亡地点，精神分裂症患者死于精神科（44.8% (95% CI 41.7 - 48.9)）。精神分裂症患者接受心肺复苏（CPR）的比例较低（16.6%对20.5%）。结论：本研究揭示了精神分裂症住院患者的死亡地点和高强度临终关怀的提供，利用日本的NDB。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

BMJ Supportive & Palliative Care Medicine-Medicine (miscellaneous)

CiteScore

4.60

自引率

7.40%

发文量

170

期刊介绍： Published quarterly in print and continuously online, BMJ Supportive & Palliative Care aims to connect many disciplines and specialties throughout the world by providing high quality, clinically relevant research, reviews, comment, information and news of international importance. We hold an inclusive view of supportive and palliative care research and we are able to call on expertise to critique the whole range of methodologies within the subject, including those working in transitional research, clinical trials, epidemiology, behavioural sciences, ethics and health service research. Articles with relevance to clinical practice and clinical service development will be considered for publication. In an international context, many different categories of clinician and healthcare workers do clinical work associated with palliative medicine, specialist or generalist palliative care, supportive care, psychosocial-oncology and end of life care. We wish to engage many specialties, not only those traditionally associated with supportive and palliative care. We hope to extend the readership to doctors, nurses, other healthcare workers and researchers in medical and surgical specialties, including but not limited to cardiology, gastroenterology, geriatrics, neurology, oncology, paediatrics, primary care, psychiatry, psychology, renal medicine, respiratory medicine.