Risk factors for hospital death in conditions needing palliative care: Nationwide population-based death certificate study

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.

In-hospital dementia-related deaths following implementation of the national dementia plan: observational study of national death certificates from 1996 to 2016

“…Our sample was similar to other countries in demographic characteristics such as age and sex 11. However, the proportion of deaths for which Alzheimer’s disease or another type of dementia was the primary cause in Japan (1.0%) was lower relative to those observed in Portugal (5.5%)13 and Belgium (9.8%) 26. The number of deaths resulting from senility was higher relative to those resulting from Alzheimer’s disease or vascular or other types of dementia.…”

“…As clinical diagnoses of dementia are under-reported as the main cause of death on death certificates,20 21 deaths resulting from senility (ICD-10, R54) were also extracted from the mortality data. Senility is included in the following category that requires palliative care: ‘Alzheimer’s disease, dementia and senility’ 13…”

Perception of a “good death” in Thai patients with cancer and their relatives

“…Furthermore, cultural differences might be an issue. Disclosure of cancer diagnosis and prognosis might be delayed in Asian countries, which means that discussion regarding the patient's wishes during their end-of-life period (including place of death) may also be delayed (Gomes et al., 2018).…”

Conhecimento sobre Cuidados Paliativos em Estudantes de Medicina da Universidade de Coimbra

“…2 Em Portugal, 70,7% das mortes de adultos são por condições que beneficiariam de CP. 3 Apesar da Lei de Bases dos Cuidados Paliativos (Lei n.º 52/2012) ter assegurado o direito de acesso dos cidadãos portugueses a estes cuidados e criado a Rede Nacional de Cuidados Paliativos (RNCP), 4 ainda existem défices e assimetrias de cobertura, entraves na referenciação e falta de recursos humanos. 5 Além disso, o país quase não tem serviços de cuidados paliativos pediátricos (CPP) e as suas necessidades são crescentes.…”