Objective To measure the associations between newly initiated palliative care in the last six months of life, healthcare use, and location of death in adults dying from non-cancer illness, and to compare these associations with those in adults who die from cancer at a population level. Design Population based matched cohort study. Setting Ontario, Canada between 2010 and 2015. Participants 113 540 adults dying from cancer and non-cancer illness who were given newly initiated physician delivered palliative care in the last six months of life administered across all healthcare settings. Linked health administrative data were used to directly match patients on cause of death, hospital frailty risk score, presence of metastatic cancer, residential location (according to 1 of 14 local health integration networks that organise all healthcare services in Ontario), and a propensity score to receive palliative care that was derived by using age and sex. Main outcome measures Rates of emergency department visits, admissions to hospital, and admissions to the intensive care unit, and odds of death at home versus in hospital after first palliative care visit, adjusted for patient characteristics (such as age, sex, and comorbidities). Results In patients dying from non-cancer illness related to chronic organ failure (such as heart failure, cirrhosis, and stroke), palliative care was associated with reduced rates of emergency department visits (crude rate 1.9 (standard deviation 6.2) v 2.9 (8.7) per person year; adjusted rate ratio 0.88, 95% confidence interval 0.85 to 0.91), admissions to hospital (crude rate 6.1 (standard deviation 10.2) v 8.7 (12.6) per person year; adjusted rate ratio 0.88, 95% confidence interval 0.86 to 0.91), and admissions to the intensive care unit (crude rate 1.4 (standard deviation 5.9) v 2.9 (8.7) per person year; adjusted rate ratio 0.59, 95% confidence interval 0.56 to 0.62) compared with those who did not receive palliative care. Additionally increased odds of dying at home or in a nursing home compared with dying in hospital were found in these patients (n=6936 (49.5%) v n=9526 (39.6%); adjusted odds ratio 1.67, 95% confidence interval 1.60 to 1.74). Overall, in patients dying from dementia, palliative care was associated with increased rates of emergency department visits (crude rate 1.2 (standard deviation 4.9) v 1.3 (5.5) per person year; adjusted rate ratio 1.06, 95% confidence interval 1.01 to 1.12) and admissions to hospital (crude rate 3.6 (standard deviation 8.2) v 2.8 (7.8) per person year; adjusted rate ratio 1.33, 95% confidence interval 1.27 to 1.39), and reduced odds of dying at home or in a nursing home (n=6667 (72.1%) v n=13 384 (83.5%); adjusted odds ratio 0.68, 95% confidence interval 0.64 to 0.73). However, these rates differed depending on whether patients dying with dementia lived in the community or in a nursing home. No association was found between healthcare use and palliative care for patients dying from dementia who lived in the community, and these patients had increased odds of dying at home. Conclusions These findings highlight the potential benefits of palliative care in some non-cancer illnesses. Increasing access to palliative care through sustained investment in physician training and current models of collaborative palliative care could improve end-of-life care, which might have important implications for health policy.

中文翻译：

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患有晚期非癌症疾病的成年人的姑息治疗与医疗保健结果之间的关联：基于人群的匹配队列研究。

目的 测量死于非癌症疾病的成年人在生命的最后六个月内新启动的姑息治疗、医疗保健使用和死亡地点之间的关联，并将这些关联与人群中死于癌症的成年人进行比较等级。设计基于人群的匹配队列研究。在 2010 年至 2015 年期间设置加拿大安大略省。参与者 113,540 名死于癌症和非癌症疾病的成年人在生命的最后六个月内接受了新开始的医生提供的姑息治疗，这些患者在所有医疗保健机构进行管理。相关的健康管理数据用于直接匹配患者的死因、医院虚弱风险评分、转移性癌症的存在、居住地点（根据在安大略省组织所有医疗保健服务的 14 个当地健康整合网络中的 1 个），以及根据年龄和性别得出的接受姑息治疗的倾向得分。主要结果测量 急诊科就诊率、入院率和重症监护病房入院率，以及首次姑息治疗就诊后在家中与住院的死亡率，并根据患者特征（如年龄、性别和合并症）进行调整. 结果 在死于与慢性器官衰竭（如心力衰竭、肝硬化和中风）相关的非癌症疾病的患者中，姑息治疗与急诊就诊率降低相关（粗率 1.9（标准差 6.2）v 2.9（8.7 ) 每人年；调整后的比率为 0.88，95% 置信区间为 0.85 至 0.91)，入院率（粗率 6.1（标准差 10.2）v 8.7（12.6）/人年；调整后的比率为 0.88，95% 置信区间 0.86 至 0.91），入住重症监护室（粗率 1.4（标准差 5.9） ) v 2.9 (8.7) 每人年；调整后的比率为 0.59，95% 置信区间为 0.56 至 0.62) 与未接受姑息治疗的人相比。此外，在这些患者中发现在家中或疗养院死亡的几率比在医院死亡的几率增加（n=6936（49.5%）vn=9526（39.6%）；调整后的优势比为 1.67，95% 置信区间为 1.60 至 1.74 ）。总体而言，在死于痴呆症的患者中，姑息治疗与急诊就诊率增加相关（粗略率 1.2（标准差 4.9）v 1.3（5.5）/人年；调整后的比率为 1.06，95% 置信区间 1.01 至 1.12）和入院率（粗率 3.6（标准差 8.2）v 2.8（7.8）/人年；调整后的比率为 1.33，95% 置信区间 1.27 至 1.39），死亡几率降低家中或疗养院（n=6667（72.1%）vn=13384（83.5%）；调整优势比 0.68，95% 置信区间 0.64 至 0.73）。然而，这些比率因死于痴呆症的患者是住在社区还是住在疗养院而有所不同。对于居住在社区的死于痴呆症的患者，在医疗保健使用和姑息治疗之间没有发现任何关联，而且这些患者在家中死亡的几率增加。结论 这些发现突出了姑息治疗对一些非癌症疾病的潜在益处。