Which patients with advanced respiratory disease die in hospital? A 14-year population-based study of trends and associated factors

Irene J. Higginson, Charles C. Reilly, Sabrina Bajwah, Matthew Maddocks, Massimo Costantini, Wei Gao, Julia Verne, Myer Glickman, Barbara Gomes, Tony Bonser, Shaheen Khan, Jonathan Koffman, Katie Lindsey, Roberta Lovick, Tariq Malik, Carolyn Morris, Andy Pring, Stafford Scholes, Katherine Sleeman, on behalf of the GUIDE_Care project

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

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.

Original languageEnglish
Article number19
JournalBMC Medicine
Volume15
Issue number1
DOIs
Publication statusPublished - Feb 1 2017

Fingerprint

Interstitial Lung Diseases
Chronic Obstructive Pulmonary Disease
Population
Comorbidity
Terminal Care
Palliative Care
Morbidity
Hospices
Marital Status
England
Observational Studies
Demography

Keywords

  • Chronic obstructive pulmonary disease
  • End of life care
  • Hospital
  • Interstitial lung disease
  • Interstitial pulmonary diseases
  • Palliative care
  • Place of death
  • Policy
  • Respiratory

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Which patients with advanced respiratory disease die in hospital? A 14-year population-based study of trends and associated factors. / Higginson, Irene J.; Reilly, Charles C.; Bajwah, Sabrina; Maddocks, Matthew; Costantini, Massimo; Gao, Wei; Verne, Julia; Glickman, Myer; Gomes, Barbara; Bonser, Tony; Khan, Shaheen; Koffman, Jonathan; Lindsey, Katie; Lovick, Roberta; Malik, Tariq; Morris, Carolyn; Pring, Andy; Scholes, Stafford; Sleeman, Katherine; on behalf of the GUIDE_Care project.

In: BMC Medicine, Vol. 15, No. 1, 19, 01.02.2017.

Research output: Contribution to journalArticle

Higginson, IJ, Reilly, CC, Bajwah, S, Maddocks, M, Costantini, M, Gao, W, Verne, J, Glickman, M, Gomes, B, Bonser, T, Khan, S, Koffman, J, Lindsey, K, Lovick, R, Malik, T, Morris, C, Pring, A, Scholes, S, Sleeman, K & on behalf of the GUIDE_Care project 2017, 'Which patients with advanced respiratory disease die in hospital? A 14-year population-based study of trends and associated factors', BMC Medicine, vol. 15, no. 1, 19. https://doi.org/10.1186/s12916-016-0776-2
Higginson, Irene J. ; Reilly, Charles C. ; Bajwah, Sabrina ; Maddocks, Matthew ; Costantini, Massimo ; Gao, Wei ; Verne, Julia ; Glickman, Myer ; Gomes, Barbara ; Bonser, Tony ; Khan, Shaheen ; Koffman, Jonathan ; Lindsey, Katie ; Lovick, Roberta ; Malik, Tariq ; Morris, Carolyn ; Pring, Andy ; Scholes, Stafford ; Sleeman, Katherine ; on behalf of the GUIDE_Care project. / Which patients with advanced respiratory disease die in hospital? A 14-year population-based study of trends and associated factors. In: BMC Medicine. 2017 ; Vol. 15, No. 1.
@article{9a159d91347e45868ef1102ff8cd1e39,
title = "Which patients with advanced respiratory disease die in hospital? A 14-year population-based study of trends and associated factors",
abstract = "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.",
keywords = "Chronic obstructive pulmonary disease, End of life care, Hospital, Interstitial lung disease, Interstitial pulmonary diseases, Palliative care, Place of death, Policy, Respiratory",
author = "Higginson, {Irene J.} and Reilly, {Charles C.} and Sabrina Bajwah and Matthew Maddocks and Massimo Costantini and Wei Gao and Julia Verne and Myer Glickman and Barbara Gomes and Tony Bonser and Shaheen Khan and Jonathan Koffman and Katie Lindsey and Roberta Lovick and Tariq Malik and Carolyn Morris and Andy Pring and Stafford Scholes and Katherine Sleeman and {on behalf of the GUIDE_Care project}",
year = "2017",
month = "2",
day = "1",
doi = "10.1186/s12916-016-0776-2",
language = "English",
volume = "15",
journal = "BMC Medicine",
issn = "1741-7015",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - Which patients with advanced respiratory disease die in hospital? A 14-year population-based study of trends and associated factors

AU - Higginson, Irene J.

AU - Reilly, Charles C.

AU - Bajwah, Sabrina

AU - Maddocks, Matthew

AU - Costantini, Massimo

AU - Gao, Wei

AU - Verne, Julia

AU - Glickman, Myer

AU - Gomes, Barbara

AU - Bonser, Tony

AU - Khan, Shaheen

AU - Koffman, Jonathan

AU - Lindsey, Katie

AU - Lovick, Roberta

AU - Malik, Tariq

AU - Morris, Carolyn

AU - Pring, Andy

AU - Scholes, Stafford

AU - Sleeman, Katherine

AU - on behalf of the GUIDE_Care project

PY - 2017/2/1

Y1 - 2017/2/1

N2 - 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.

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.

KW - Chronic obstructive pulmonary disease

KW - End of life care

KW - Hospital

KW - Interstitial lung disease

KW - Interstitial pulmonary diseases

KW - Palliative care

KW - Place of death

KW - Policy

KW - Respiratory

UR - http://www.scopus.com/inward/record.url?scp=85011317351&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85011317351&partnerID=8YFLogxK

U2 - 10.1186/s12916-016-0776-2

DO - 10.1186/s12916-016-0776-2

M3 - Article

AN - SCOPUS:85011317351

VL - 15

JO - BMC Medicine

JF - BMC Medicine

SN - 1741-7015

IS - 1

M1 - 19

ER -