Determinants of the number of days people in the general population spent at home during end-of-life: Results from a population-based cohort analysis.

<h4>Background</h4>The number of days spent at home in the last six months of life has been proposed as a comprehensive indicator of high-value patient-centered care; however, information regarding the determinants of this outcome is scarce, particularly among the general population. We...

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Autores principales: Albert Dalmau-Bueno, Anna García-Altés, Jordi Amblàs, Joan Carles Contel, Sebastià Santaeugènia
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Publicado: Public Library of Science (PLoS) 2021
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spelling oai:doaj.org-article:1f08e19ee63043f294fc0a3de4e20c1e2021-12-02T20:09:14ZDeterminants of the number of days people in the general population spent at home during end-of-life: Results from a population-based cohort analysis.1932-620310.1371/journal.pone.0253483https://doaj.org/article/1f08e19ee63043f294fc0a3de4e20c1e2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0253483https://doaj.org/toc/1932-6203<h4>Background</h4>The number of days spent at home in the last six months of life has been proposed as a comprehensive indicator of high-value patient-centered care; however, information regarding the determinants of this outcome is scarce, particularly among the general population. We investigated the determinants of spending time at home within the six months preceding death.<h4>Methods</h4>Population-based, retrospective analysis of administrative databases of the Catalan government. The analysis included adult (≥18 years) individuals who died in Catalonia (North-east Spain) in 2017 and met the McNamara criteria for palliative care. The primary outcome was the number of days spent at home within the last 180 days of life. Other variables included the cause of death, demographic characteristics, and socioeconomic status, stratified as very low, low, mid, and high level.<h4>Results</h4>The analysis included 40,137 individuals (19,510 women; 20,627 men), who spent a median of 140 days (IQR 16-171) at home within the six months preceding death (women 140 [16-171]; men 150 [100-171]). Female gender was an independent factor of staying fewer days at home (OR 0.80 [95% CI 0.77-0.82]; p<0.001). Higher socioeconomic levels were significantly associated with an increasing number of days at home in both genders: among women, ORs of the low, middle, and high levels were 1.09 (0.97-1.22), 1.54 (1.36-1.75), and 2.52 (1.69-3.75) (p<0.001), respectively; the corresponding ORs among men were 1.27 (1.12-1.43), 1.56 (1.38-1.77), 2.82 (2.04-3.88) (p<0.001). The presence of dementia was a strong predictor of spending less time at home in women (0.41 (0.38-0.43); p<0.001) and men (0.45 (0.41-0.48); p<0.001).<h4>Conclusions</h4>Our results suggest that end-of-life care is associated with gender and socioeconomic inequalities; women and individuals with lower socioeconomic status spend less time at home within the last 180 days of life.Albert Dalmau-BuenoAnna García-AltésJordi AmblàsJoan Carles ContelSebastià SantaeugèniaPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 7, p e0253483 (2021)
institution DOAJ
collection DOAJ
language EN
topic Medicine
R
Science
Q
spellingShingle Medicine
R
Science
Q
Albert Dalmau-Bueno
Anna García-Altés
Jordi Amblàs
Joan Carles Contel
Sebastià Santaeugènia
Determinants of the number of days people in the general population spent at home during end-of-life: Results from a population-based cohort analysis.
description <h4>Background</h4>The number of days spent at home in the last six months of life has been proposed as a comprehensive indicator of high-value patient-centered care; however, information regarding the determinants of this outcome is scarce, particularly among the general population. We investigated the determinants of spending time at home within the six months preceding death.<h4>Methods</h4>Population-based, retrospective analysis of administrative databases of the Catalan government. The analysis included adult (≥18 years) individuals who died in Catalonia (North-east Spain) in 2017 and met the McNamara criteria for palliative care. The primary outcome was the number of days spent at home within the last 180 days of life. Other variables included the cause of death, demographic characteristics, and socioeconomic status, stratified as very low, low, mid, and high level.<h4>Results</h4>The analysis included 40,137 individuals (19,510 women; 20,627 men), who spent a median of 140 days (IQR 16-171) at home within the six months preceding death (women 140 [16-171]; men 150 [100-171]). Female gender was an independent factor of staying fewer days at home (OR 0.80 [95% CI 0.77-0.82]; p<0.001). Higher socioeconomic levels were significantly associated with an increasing number of days at home in both genders: among women, ORs of the low, middle, and high levels were 1.09 (0.97-1.22), 1.54 (1.36-1.75), and 2.52 (1.69-3.75) (p<0.001), respectively; the corresponding ORs among men were 1.27 (1.12-1.43), 1.56 (1.38-1.77), 2.82 (2.04-3.88) (p<0.001). The presence of dementia was a strong predictor of spending less time at home in women (0.41 (0.38-0.43); p<0.001) and men (0.45 (0.41-0.48); p<0.001).<h4>Conclusions</h4>Our results suggest that end-of-life care is associated with gender and socioeconomic inequalities; women and individuals with lower socioeconomic status spend less time at home within the last 180 days of life.
format article
author Albert Dalmau-Bueno
Anna García-Altés
Jordi Amblàs
Joan Carles Contel
Sebastià Santaeugènia
author_facet Albert Dalmau-Bueno
Anna García-Altés
Jordi Amblàs
Joan Carles Contel
Sebastià Santaeugènia
author_sort Albert Dalmau-Bueno
title Determinants of the number of days people in the general population spent at home during end-of-life: Results from a population-based cohort analysis.
title_short Determinants of the number of days people in the general population spent at home during end-of-life: Results from a population-based cohort analysis.
title_full Determinants of the number of days people in the general population spent at home during end-of-life: Results from a population-based cohort analysis.
title_fullStr Determinants of the number of days people in the general population spent at home during end-of-life: Results from a population-based cohort analysis.
title_full_unstemmed Determinants of the number of days people in the general population spent at home during end-of-life: Results from a population-based cohort analysis.
title_sort determinants of the number of days people in the general population spent at home during end-of-life: results from a population-based cohort analysis.
publisher Public Library of Science (PLoS)
publishDate 2021
url https://doaj.org/article/1f08e19ee63043f294fc0a3de4e20c1e
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