Trends in palliative care utilization among older adult decedents with and without cancer in Taiwan: a population-based comparative study

IF 8.1 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES The Lancet Regional Health: Western Pacific Pub Date : 2025-02-01 Epub Date: 2025-01-28 DOI:10.1016/j.lanwpc.2025.101479
Yu-Tai Lo , Tzu-Jung Chuang , Yu-Tung Huang , Yi-Lin Wu , Yi-Ching Yang , Chung-Yi Li
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Abstract

Background

The leading causes of death among the older adults have shifted from cancer to non-cancer conditions such as ischemia heart diseases, stroke, and dementia, affecting end-of-life care needs. This study examined the difference in the proportion of palliative care utilization in relation to specific causes of death and compared the trends in palliative care utilization between older adult decedents with and without cancer in Taiwan from 2010 to 2020.

Methods

The study utilized data from the Health and Welfare Data Science Center in Taiwan, covering demographic and healthcare variables for 588,010 decedents aged 65+ years who died between 2010 and 2020. We used Poisson regression to investigate the temporal trends in palliative care utilization during the last six months of life. Multivariable logistic regression models were constructed to analyze cancer, and non-cancer causes of death associated with palliative care utilization.

Findings

The proportion of palliative utilization in cancer deaths started at 21.7% in 2010 and increased to 63.2% by 2020 with the beta coefficient of 0.09 (95% CI: 0.09–0.09). The proportion of palliative utilization in non-cancer deaths started at 0.8% in 2010 and increased to 23.5% by 2020, with the beta coefficient of 0.26 (95% CI: 0.26–0.26). Compared to deceased cancer patients, deceased non-cancer individuals were less likely to have received palliative care (OR = 0.12, 95% CI: 0.12–0.13).

Interpretation

Efforts to ensure equitable access to palliative care for non-cancer individuals should focus on expanding services, enhancing provider education, and promoting cultural sensitivity to meet the growing need for palliative care integration.

Funding

This study was supported in part by grants from the National Cheng Kung University Hospital (NCKUH-11305001, NCKUH-V101-10) and the National Health Research Institutes (NHRI-13A1-CG-CO-04-2225-1). The sponsors had no influence on the study.
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台湾有与无癌症之老年死者缓和疗护使用趋势:一项以人口为基础的比较研究
背景:老年人的主要死亡原因已经从癌症转向非癌症疾病,如缺血心脏病、中风和痴呆,影响了临终关怀需求。本研究探讨台湾老年癌症患者使用缓和疗护的比例与特定死因的差异,并比较2010年至2020年台湾老年癌症患者与非癌症患者使用缓和疗护的趋势。方法本研究利用台湾健康福利数据科学中心的数据,涵盖2010年至2020年期间死亡的588,010名65岁以上的死者的人口统计学和医疗保健变量。我们使用泊松回归来调查在生命的最后六个月里姑息治疗使用的时间趋势。构建多变量logistic回归模型来分析与姑息治疗使用相关的癌症和非癌症死亡原因。结果:2010年,姑息治疗在癌症死亡中所占的比例为21.7%,到2020年增加到63.2%,贝塔系数为0.09 (95% CI: 0.09 - 0.09)。2010年,姑息治疗在非癌症死亡中的比例为0.8%,到2020年增加到23.5%,贝塔系数为0.26 (95% CI: 0.26 - 0.26)。与死亡的癌症患者相比,死亡的非癌症患者接受姑息治疗的可能性更低(OR = 0.12, 95% CI: 0.12 - 0.13)。确保非癌症个体公平获得姑息治疗的努力应侧重于扩大服务,加强提供者教育,提高文化敏感性,以满足日益增长的姑息治疗整合需求。本研究得到了国立成功大学医院(NCKUH-11305001, NCKUH-V101-10)和国立卫生研究院(NHRI-13A1-CG-CO-04-2225-1)的部分资助。赞助者对研究没有影响。
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来源期刊
The Lancet Regional Health: Western Pacific
The Lancet Regional Health: Western Pacific Medicine-Pediatrics, Perinatology and Child Health
CiteScore
8.80
自引率
2.80%
发文量
305
审稿时长
11 weeks
期刊介绍: The Lancet Regional Health – Western Pacific, a gold open access journal, is an integral part of The Lancet's global initiative advocating for healthcare quality and access worldwide. It aims to advance clinical practice and health policy in the Western Pacific region, contributing to enhanced health outcomes. The journal publishes high-quality original research shedding light on clinical practice and health policy in the region. It also includes reviews, commentaries, and opinion pieces covering diverse regional health topics, such as infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, aging health, mental health, the health workforce and systems, and health policy.
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