PMID- 28143520
OWN - NLM
STAT- MEDLINE
DCOM- 20170524
LR  - 20240214
IS  - 1741-7015 (Electronic)
IS  - 1741-7015 (Linking)
VI  - 15
IP  - 1
DP  - 2017 Feb 1
TI  - Which patients with advanced respiratory disease die in hospital? A 14-year 
      population-based study of trends and associated factors.
PG  - 19
LID - 10.1186/s12916-016-0776-2 [doi]
LID - 19
AB  - BACKGROUND: Strategies in many countries have sought to improve palliative care 
      and reduce hospital deaths for non-cancer patients, but their effects are not 
      evaluated. We aimed to determine the trends and factors associated with dying in 
      hospital in two common progressive respiratory diseases, and the impact of a 
      national end of life care (EoLC) strategy to reduce deaths in hospital. METHODS: 
      This population-based observational study linked death registration data for 
      people in England dying from chronic obstructive pulmonary disease (COPD) or 
      interstitial pulmonary diseases (IPD). We plotted age- and sex-standardised 
      trends, assessed during the pre-strategy (2001-2004), first strategy phase 
      (2004-2008), and strategy intensification (2009-2014) periods, and identified 
      factors associated with hospital death using multiple adjusted proportion ratios 
      (PRs). RESULTS: Over 14 years, 380,232 people died from COPD (334,520) or IPD 
      (45,712). Deaths from COPD and IPD increased by 0.9% and 9.2% annually, 
      respectively. Death in hospital was most common (67% COPD, 70% IPD). Dying in 
      hospice was rare (0.9% COPD, 2.9% IPD). After a plateau in 2004-2005, hospital 
      deaths fell (PRs 0.92-0.94). Co-morbidities and deprivation independently 
      increased the chances of dying in hospital, with larger effects in IPD (PRs 
      1.01-1.55) than COPD (PRs 1.01-1.39) and dose-response gradients. The impact of 
      multimorbidity increased over time; hospital deaths did not fall for people with 
      two or more co-morbidities in COPD, nor one or more in IPD. Living in rural areas 
      (PRs 0.94-0.94) or outside London (PRs, 0.89-0.98) reduced the chances of 
      hospital death. In IPD, increased age reduced the likelihood of hospital death 
      (PR 0.81, >/= 85 versus </= 54 years); divergently, in COPD, being aged 65-74 years 
      was associated with increased hospital deaths (PR 1.13, versus </= 54 years). The 
      independent effects of sex and marital status differed for COPD versus IPD (PRs 
      0.89-1.04); in COPD, hospital death was associated with being married. 
      CONCLUSIONS: The EoLC strategy appeared to have contributed to tangible 
      reductions in hospital deaths, but did not reach people with multimorbidity and 
      this gap widened over time. Integrating palliative care earlier in the disease 
      trajectory especially in deprived areas and cities, and where multimorbidity is 
      present, should be boosted, taking into account the different demographic factors 
      in COPD and IPD.
FAU - Higginson, Irene J
AU  - Higginson IJ
AD  - Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's 
      College London, Bessemer Road, London, SE5 9PJ, UK. irene.higginson@kcl.ac.uk.
FAU - Reilly, Charles C
AU  - Reilly CC
AD  - Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's 
      College London, Bessemer Road, London, SE5 9PJ, UK.
FAU - Bajwah, Sabrina
AU  - Bajwah S
AD  - Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's 
      College London, Bessemer Road, London, SE5 9PJ, UK.
FAU - Maddocks, Matthew
AU  - Maddocks M
AD  - Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's 
      College London, Bessemer Road, London, SE5 9PJ, UK.
FAU - Costantini, Massimo
AU  - Costantini M
AD  - Arcispedale Santa Maria Nuova-IRCCS, Viale Umberto I, 50 - 42123, Reggio Emilia, 
      Italy.
FAU - Gao, Wei
AU  - Gao W
AD  - Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's 
      College London, Bessemer Road, London, SE5 9PJ, UK.
CN  - GUIDE_Care project
LA  - eng
GR  - 09/2000/58/DH_/Department of Health/United Kingdom
GR  - HS&DR/14/19/22/DH_/Department of Health/United Kingdom
GR  - MCCC-RP-15-A18859/MCCC_/Marie Curie/United Kingdom
GR  - PB-PG-0107-12109/DH_/Department of Health/United Kingdom
PT  - Journal Article
DEP - 20170201
PL  - England
TA  - BMC Med
JT  - BMC medicine
JID - 101190723
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - England/epidemiology
MH  - Female
MH  - Hospital Mortality
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Respiratory Tract Diseases/*mortality
MH  - *Terminal Care
PMC - PMC5286738
OTO - NOTNLM
OT  - Chronic obstructive pulmonary disease
OT  - End of life care
OT  - Hospital
OT  - Interstitial lung disease
OT  - Interstitial pulmonary diseases
OT  - Palliative care
OT  - Place of death
OT  - Policy
OT  - Respiratory
EDAT- 2017/02/02 06:00
MHDA- 2017/05/26 06:00
PMCR- 2017/02/01
CRDT- 2017/02/02 06:00
PHST- 2016/10/07 00:00 [received]
PHST- 2016/12/23 00:00 [accepted]
PHST- 2017/02/02 06:00 [entrez]
PHST- 2017/02/02 06:00 [pubmed]
PHST- 2017/05/26 06:00 [medline]
PHST- 2017/02/01 00:00 [pmc-release]
AID - 10.1186/s12916-016-0776-2 [pii]
AID - 776 [pii]
AID - 10.1186/s12916-016-0776-2 [doi]
PST - epublish
SO  - BMC Med. 2017 Feb 1;15(1):19. doi: 10.1186/s12916-016-0776-2.