Department of Clinical Epidemiology (DCE)

TY - JOUR

T1 - Hospitalisation at the end of life among cancer and non-cancer patients in Denmark

T2 - A nationwide register-based cohort study

AU - Vestergaard, Anne Høy Seemann

AU - Neergaard, Mette Asbjoern

AU - Christiansen, Christian Fynbo

AU - Nielsen, Henrik

AU - Lyngaa, Thomas

AU - Laut, Kristina Grønborg

AU - Johnsen, Søren Paaske

PY - 2020/5

Y1 - 2020/5

N2 - Objectives End-of-life hospitalisations may not be associated with improved quality of life. Studies indicate differences in end-of-life care for cancer and non-cancer patients; however, data on hospital utilisation are sparse. This study aimed to compare end-of-life hospitalisation and place of death among patients dying from cancer, heart failure or chronic obstructive pulmonary disease (COPD). Design A nationwide register-based cohort study. Setting Data on all in-hospital admissions obtained from nationwide Danish medical registries. Participants All decedents dying from cancer, heart failure or COPD disease in Denmark between 2006 and 2015. Outcome measures Data on all in-hospital admissions within 6 months and 30 days before death as well as place of death. Comparisons were made according to cause of death while adjusting for age, sex, comorbidity, partner status and residential region. Results Among 154 235 decedents, the median total bed days in hospital within 6 months before death was 19 days for cancer patients, 10 days for patients with heart failure and 11 days for patients with COPD. Within 30 days before death, this was 9 days for cancer patients, and 6 days for patients with heart failure and COPD. Compared with cancer patients, the adjusted relative bed day use was 0.65 (95% CI, 0.63 to 0.68) for heart failure patients and 0.68 (95% CI, 0.66 to 0.69) for patients with COPD within 6 months before death. Correspondingly, this was 0.65 (95% CI, 0.63 to 0.68) and 0.70 (95% CI, 0.68 to 0.71) within 30 days before death. Patients had almost the same risk of dying in hospital independently of death cause (46.2% to 56.0%). Conclusion Patients with cancer, heart failure and COPD all spent considerable part of their end of life in hospital. Hospital use was highest among cancer patients; however, absolute differences were small.

AB - Objectives End-of-life hospitalisations may not be associated with improved quality of life. Studies indicate differences in end-of-life care for cancer and non-cancer patients; however, data on hospital utilisation are sparse. This study aimed to compare end-of-life hospitalisation and place of death among patients dying from cancer, heart failure or chronic obstructive pulmonary disease (COPD). Design A nationwide register-based cohort study. Setting Data on all in-hospital admissions obtained from nationwide Danish medical registries. Participants All decedents dying from cancer, heart failure or COPD disease in Denmark between 2006 and 2015. Outcome measures Data on all in-hospital admissions within 6 months and 30 days before death as well as place of death. Comparisons were made according to cause of death while adjusting for age, sex, comorbidity, partner status and residential region. Results Among 154 235 decedents, the median total bed days in hospital within 6 months before death was 19 days for cancer patients, 10 days for patients with heart failure and 11 days for patients with COPD. Within 30 days before death, this was 9 days for cancer patients, and 6 days for patients with heart failure and COPD. Compared with cancer patients, the adjusted relative bed day use was 0.65 (95% CI, 0.63 to 0.68) for heart failure patients and 0.68 (95% CI, 0.66 to 0.69) for patients with COPD within 6 months before death. Correspondingly, this was 0.65 (95% CI, 0.63 to 0.68) and 0.70 (95% CI, 0.68 to 0.71) within 30 days before death. Patients had almost the same risk of dying in hospital independently of death cause (46.2% to 56.0%). Conclusion Patients with cancer, heart failure and COPD all spent considerable part of their end of life in hospital. Hospital use was highest among cancer patients; however, absolute differences were small.

KW - chronic disease

KW - death

KW - hospital

KW - neoplasms

KW - palliative care

KW - terminal care

UR - http://www.scopus.com/inward/record.url?scp=85087253681&partnerID=8YFLogxK

U2 - 10.1136/bmjopen-2019-033493

DO - 10.1136/bmjopen-2019-033493

M3 - Journal article

C2 - 32595146

AN - SCOPUS:85087253681

VL - 10

JO - B M J Open

JF - B M J Open

SN - 2044-6055

IS - 6

M1 - e033493

ER -