Disparities in Asians’ Hospice Utilization and Location of Death

Abstract Background On 13 March 2020, the Danish authorities imposed extensive nationwide lockdown measures to prevent the spread of the coronavirus disease 2019 (COVID-19) and reallocated limited healthcare resources. We investigated mortality rates, overall and according to location, in patients with established cardiovascular disease before, during, and after these lockdown measures. Methods and results Using Danish nationwide registries, we identified a dynamic cohort comprising all Danish citizens with cardiovascular disease (i.e. a history of ischaemic heart disease, ischaemic stroke, heart failure, atrial fibrillation, or peripheral artery disease) alive on 2 January 2019 and 2020. The cohort was followed from 2 January 2019/2020 until death or 16/15 October 2019/2020. The cohort comprised 340 392 and 347 136 patients with cardiovascular disease in 2019 and 2020, respectively. The overall, in-hospital, and out-of-hospital mortality rate in 2020 before lockdown was significantly lower compared with the same period in 2019 [adjusted incidence rate ratio (IRR) 0.91, 95% confidence interval (CI) CI 0.87–0.95; IRR 0.95, 95% CI 0.89–1.02; and IRR 0.87, 95% CI 0.83–0.93, respectively]. The overall mortality rate during and after lockdown was not significantly different compared with the same period in 2019 (IRR 0.99, 95% CI 0.97–1.02). However, the in-hospital mortality rate was lower and out-of-hospital mortality rate higher during and after lockdown compared with the same period in 2019 (in-hospital, IRR 0.92, 95% CI 0.88–0.96; out-of-hospital, IRR 1.04, 95% CI1.01–1.08). These trends were consistent irrespective of sex and age. Conclusions Among patients with established cardiovascular disease, the in-hospital mortality rate was lower and out-of-hospital mortality rate higher during lockdown compared with the same period in the preceding year, irrespective of age and sex.

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Impact of the Human Microbiome in Forensic Sciences: a Systematic Review

Applied and Environmental Microbiology ◽

10.1128/aem.01451-20 ◽

2020 ◽

Vol 86 (22) ◽

Author(s):

Manuel G. García ◽

María D. Pérez-Cárceles ◽

Eduardo Osuna ◽

Isabel Legaz

Keyword(s):

Systematic Review ◽

Forensic Science ◽

Human Microbiome ◽

Geographical Location ◽

Postmortem Interval ◽

Forensic Sciences ◽

Content Type ◽

Microbiome Analysis ◽

Location Of Death ◽

Microbiome Research

ABSTRACT Numerous studies relate differences in microbial communities to human health and disease; however, little is known about microbial changes that occur postmortem or the possible applications of microbiome analysis in the field of forensic science. The aim of this review was to study the microbiome and its applications in forensic sciences and to determine the main lines of investigation that are emerging, as well as its possible contributions to the forensic field. A systematic review of the human microbiome in relation to forensic science was carried out by following PRISMA guidelines. This study sheds light on the role of microbiome research in the postmortem interval during the process of decomposition, identifying death caused by drowning or sudden death, locating the geographical location of death, establishing a connection between the human microbiome and personal items, sexual contact, and the identification of individuals. Actinomycetaceae, Bacteroidaceae, Alcaligenaceae, and Bacilli play an important role in determining the postmortem interval. Aeromonas can be used to determine the cause of death, and Corynebacterium or Helicobacter pylori can be used to ascertain personal identity or geographical location. Several studies point to a promising future for microbiome analysis in the different fields of forensic science, opening up an important new area of research.

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Trends in Location of Death in Patients With Aortic Aneurysm and Dissection

OMEGA - Journal of Death and Dying ◽

10.1177/0030222820951650 ◽

2020 ◽

pp. 003022282095165

Author(s):

Danielle DeCicco ◽

Ziad O. Dimachkie ◽

Muhammad Z. Khan ◽

Muhammad S. Khan ◽

Muhammad U. Khan ◽

...

Keyword(s):

End Of Life Care ◽

Research Database ◽

Life Care ◽

Online Data ◽

Location Of Death ◽

Aortic Aneurysm And Dissection ◽

Control And Prevention ◽

Dying At Home ◽

Aortic Dissections ◽

At Home

Aortic dissections and aneurysms (ADA) are associated with significant morbidity and mortality, and location of death for these patients is important in determining impact on end of life care. We analyzed the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research database. Black and Hispanic backgrounds had decreased odds of dying at home from ADA. Married or educated individuals tended to die at home at a higher rate than unmarried individuals. Overall, we have shown place of death in individuals with ADA is different among individuals of different demographics.

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Survival, Mortality, and Location of Death for Patients Seen by a Hospital-Based Palliative Care Team

Journal of Palliative Medicine ◽

10.1089/jpm.2006.9.903 ◽

2006 ◽

Vol 9 (4) ◽

pp. 903-911 ◽

Cited By ~ 44

Author(s):

Erik K. Fromme ◽

Paul B. Bascom ◽

M.D. Smith ◽

Susan W. Tolle ◽

Lissi Hanson ◽

...

Keyword(s):

Palliative Care ◽

Palliative Care Team ◽

Care Team ◽

Location Of Death

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Short Report: Preferences for location of death of seriously ill hospitalized patients: perspectives from Canadian patients and their family caregivers

Palliative Medicine ◽

10.1177/0269216307084612 ◽

2008 ◽

Vol 22 (1) ◽

pp. 85-88 ◽

Cited By ~ 51

Author(s):

Kelli I. Stajduhar ◽

Diane E. Allan ◽

S. Robin Cohen ◽

Daren K. Heyland

Keyword(s):

Family Caregivers ◽

Hospitalized Patients ◽

Short Report ◽

Location Of Death ◽

Seriously Ill

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Duration of palliative care involvement and cancer care aggressiveness near the end of life

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2020-002641 ◽

2020 ◽

pp. bmjspcare-2020-002641

Author(s):

Pierre Antoine Monier ◽

Jan Chrusciel ◽

Fiona Ecarnot ◽

Eduardo Bruera ◽

Stephane Sanchez ◽

...

Keyword(s):

Palliative Care ◽

End Of Life ◽

Teaching Hospital ◽

Cancer Care ◽

Data Privacy ◽

National Commission ◽

Care Group ◽

Location Of Death ◽

Aggressive Cancer ◽

Hospital Ethics

ObjectivesPrevious studies have found an association between aggressive cancer care and lower quality end of life. Despite international recommendations, late or very late referral to palliative care seems frequent. This study aimed to evaluate the association between the duration of involvement of a palliative care team (PCT), and aggressive cancer care, and to identify factors associated with aggressive cancer care.MethodsWe performed an observational retrospective study in a single academic teaching hospital. In total, 561 inpatients with solid tumours or haematological malignancies were included. Patients followed by a PCT for at least 1 month before death were classified in the palliative care group. Aggressive cancer care was defined as: hospitalisations and/or a new line of chemotherapy within the last month of life, location of death, the use of chemotherapy in the last 2 weeks and hospice admissions within the last 3 days of life.ResultsAmong the 561 patients, 241 (43%) were referred to the PCT; 89 (16%) were followed by the PCT for a month or more before death. In the last 2 weeks of life, 124 (22%) patients received chemotherapy, 110 (20%) died in an acute care unit. At least one criterion of aggressive cancer care was found in 395 patients overall (71%). Aggressive cancer care was significantly less frequent when the PCT referral occurred >1 month before death (p<0.0001).ConclusionMore studies are needed to understand reasons for late referrals despite international recommendations encouraging integrative palliative care.Ethics approvalThe study was approved by the Grenoble Teaching Hospital ethics committee, and by the CNIL (French national commission for data privacy; Commission Nationale de l’Informatique et des Libertés) under the number 1987785 v 0. Due to ethical and legal restrictions, data are only available on request.

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Persistent socioeconomic inequalities in location of death and receipt of palliative care: A population-based cohort study

Palliative Medicine ◽

10.1177/0269216320947964 ◽

2020 ◽

Vol 34 (10) ◽

pp. 1393-1401

Author(s):

Luke Mondor ◽

Walter P Wodchis ◽

Peter Tanuseputro

Keyword(s):

Palliative Care ◽

Cohort Study ◽

End Of Life ◽

Terminal Illness ◽

Home Visits ◽

Population Based ◽

Relative Index ◽

Deprived Neighbourhoods ◽

Location Of Death ◽

Index Of Inequality

Background: Providing equitable care to patients in need across the life course is a priority for many healthcare systems. Aim: To estimate socioeconomic inequality trends in the proportions of decedents that died in the community and that received palliative care within 30 days of death (including home visits and specialist/generalist physician encounters). Design: Cohort study based on health administrative data. Socioeconomic position was measured by area-level material deprivation. Inequality gaps were quantified annually and longitudinally using the slope index of inequality (absolute gap) and relative index of inequality (relative gap). Setting/Participants: A total of 729,290 decedents aged ⩾18 years in Ontario, Canada from 2009 to 2016. Results: In 2016, the modelled absolute gap (corresponding 95% confidence interval) between the most- and least-deprived neighbourhoods in community deaths was 4.0% (2.9–5.1%), which was 8.6% (6.2–10.9%) of the overall mean (46.6%). Relative to 2009, these inequalities declined modestly. Inequalities in 2016 were evident for palliative home visits (6.8% (5.8–7.8%) absolute gap, 26.3% (22.5–30.0%) relative gap) and for physician encounters (6.8% (5.7–7.9%) absolute gap, 13.2% (11.0–15.3%) relative gap), and widened from 2009 for physician encounters only on the absolute scale. Inequalities varied considerably across disease trajectories (organ failure, terminal illness, frailty, and sudden death). Conclusion: Key measures of end-of-life care are not achieved equally across socioeconomic groups. These data can be used to inform policy strategies to improve delivery of palliative and end-of-life services.

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