Purpose

To investigate the patterns of healthcare use (HCU) at the last year of life in persons with osteoarthritis (OA).

Methods

Using linked registers, we identified persons aged≥ 65 years who died during 2003–2014 and were resided in the Skåne region during 5-year prior to death. Among these, we randomly matched decedents with a principal OA diagnosis prior to the last year of life (OA cohort, n = 17,993) with up to 4 comparators without OA by sex, age at death, and year of death (n = 59,945). We measured monthly HCU for each decedent during last year of life and applied two-part regression models to estimate HCU attributable to OA. Group-based trajectory modelling (GBTM) was used to detect distinct trajectories of HCU within the OA cohort.

Results

During last 12-month of life, each person with OA had, on average, 2.5 (95% CI 2.2, 2.7) excess healthcare consultations and 1.8 (95% CI 1.3, 2.2) more inpatient days than those without OA. While both cohorts observed increasing trends in HCU towards death, excess healthcare consultations attributable to OA declined and inpatient days increased as death approached. For both healthcare consultations and inpatient days, GBTM identified four distinct trajectory classes. While underlying cause of death and age were the most important predictors of class membership, the overall predictive accuracy was poor.

Conclusion

OA was associated with excess HCU especially hospital-based care during the last year of life. However, there seem to be distinct trajectory classes within the OA patient population.

中文翻译：

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骨关节炎患者临终医疗保健使用的变异性：一项基于人群的匹配队列研究

目的

调查骨关节炎 (OA) 患者生命最后一年的医疗保健使用 (HCU) 模式。

方法

使用关联登记册，我们确定了 2003 年至 2014 年期间死亡且在死亡前 5 年内居住在斯科讷地区的年龄≥65 岁的人。其中，我们随机匹配在生命的最后一年（OA 队列，n  = 17,993）之前有主要 OA 诊断的死者与多达 4 个没有 OA 的比较者按性别、死亡年龄和死亡年份（n  = 59,945） . 我们测量了每个死者在生命最后一年的每月 HCU，并应用两部分回归模型来估计归因于 OA 的 HCU。基于组的轨迹建模 (GBTM) 用于检测 OA 队列中 HCU 的不同轨迹。

结果

在生命的最后 12 个月中，与没有 OA 的人相比，每个患有 OA 的人平均有 2.5 (95% CI 2.2, 2.7) 的额外医疗咨询和 1.8 (95% CI 1.3, 2.2) 的住院天数。虽然这两个队列都观察到 HCU 的死亡趋势呈上升趋势，但随着死亡的临近，由于 OA 导致的过度医疗咨询下降，住院天数增加。对于医疗保健咨询和住院日，GBTM 确定了四个不同的轨迹类别。虽然死亡的根本原因和年龄是班级成员的最重要预测因素，但总体预测准确性很差。

结论

OA 与 HCU 过多有关，尤其是生命最后一年的医院护理。然而，OA 患者群体中似乎存在不同的轨迹类别。