日本高龄老人临终关怀的地区差异 :描述性研究

IF 3.7 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Michi Sakai, Naohiro Mitsutake, Tomohide Iwao, Genta Kato, Shuzo Nishimura, Takeo Nakayama
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引用次数: 0

摘要

背景:在生命的最后阶段使用维持生命的治疗(LST)是一个主要的政策问题,原因是成本增加,而其强度与质量并不相关。之前的报告显示,日本的生命维持治疗使用率呈下降趋势。然而,各地区的实践差异仍不明确。本研究旨在描述日本高龄老人死前使用 LST 的地区差异:本研究对 2013 年 4 月至 2014 年 3 月间去世的 85 岁或以上患者进行了描述性研究。研究利用日本国家数据库(NDB)中的医疗保险报销单,对生命最后 7 天中心肺复苏(CPR)、机械通气(MV)和入住急症监护病房(ACW)的使用情况进行了调查:在 224,391 名患者中,接受 LST 的患者比例因地区而异。心肺复苏的比例从 8.6%(中部)到 12.9%(四国)不等,MV 的比例从 7.1%(中部)到 12.3%(四国)不等,入住 ACW 的比例从 4.5%(中部)到 10.1%(九州冲绳)不等。与关东地区相比,地区差异的调整赔率(AOR)如下:CPR(四国,1.85 [95% CI 1.73 - 1.98])、MV(四国,1.75 [1.63 - 1.87])和 ACW 入院(九州冲绳,1.69 [1.52 - 1.88]):本研究提供了有关高龄老人使用 LST 的地区差异的描述性信息。有必要开展进一步研究,以确定造成这些差异的因素,并应对提高临终关怀质量的挑战。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Regional Variation in End-of-Life Care just before Death among the oldest old in Japan : A descriptive study

Background: The use of life-sustaining treatment (LST) in the final stage of life is a major policy concern due to increased costs, while its intensity does not correlate with quality. Previous reports have shown declining trends in LST use in Japan. However, regional practice variations remain unclear. This study aims to describe regional variations in LST use before death among the oldest old in Japan.

Methods: A descriptive study was conducted among patients aged 85 or older who passed away between April 2013 and March 2014. The study utilized health insurance claims from Japan's National Database (NDB) to examine the use of cardiopulmonary resuscitation (CPR), mechanical ventilation (MV), and admission to the acute care ward (ACW) in the last 7 days of life.

Results: Among 224,391 patients, the proportion of patients receiving LST varied by region. CPR ranged from 8.6% (Chubu) to 12.9% (Shikoku), MV ranged from 7.1% (Chubu) to 12.3% (Shikoku), and admission to ACW ranged from 4.5% (Chubu) to 10.1% (Kyushu-Okinawa). The adjusted odds ratios (AOR) for regional variation compared with Kanto were as follows: CPR (in Shikoku, 1.85 [95% CI 1.73 - 1.98]), MV (in Shikoku, 1.75 [1.63 - 1.87]), and ACW admission (in Kyushu-Okinawa, 1.69 [1.52 - 1.88]).

Conclusion: The study presents descriptive information regarding regional differences in the utilization of LST for the oldest old. Further research is necessary to identify the factors that contribute to these variations and to address the challenge of improving the quality of end-of-life care.

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来源期刊
Journal of Epidemiology
Journal of Epidemiology 医学-公共卫生、环境卫生与职业卫生
CiteScore
7.50
自引率
4.30%
发文量
172
审稿时长
6-12 weeks
期刊介绍: The Journal of Epidemiology is the official open access scientific journal of the Japan Epidemiological Association. The Journal publishes a broad range of original research on epidemiology as it relates to human health, and aims to promote communication among those engaged in the field of epidemiological research and those who use epidemiological findings.
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