智利姑息治疗需求的历史趋势与未来预测：基于常规死亡登记和人口数据的分析

Past trends and future projections of palliative care needs in Chile: analysis of routinely available death registry and population data

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BMC Medicine

影响因子:8.3

分区:医学1区 Top / 医学：内科1区

发表日期:2024 Sep 02

作者: Javiera Leniz, Angélica Domínguez, Anna E Bone, Simon Etkind, Pedro E Perez-Cruz, Katherine E Sleeman

DOI: 10.1186/s12916-024-03570-1

摘要

全球范围内，具有姑息治疗需求的人群预计将持续增加。近年来，智利出台了面向严重和终末期疾病患者（包括非癌症疾病）的普遍可及性法律，以保障其基本医疗权益。本文旨在估算至2050年，智利受严重健康相关痛苦影响及需要姑息治疗的人数。我们使用了1997-2019年智利所有死亡登记数据以及1997-2050年的人口预测数据。通过泊松回归模型，调整年龄、性别和人口数据，预测2021年至2050年各类死因的死亡人数。随后，我们应用《柳叶刀》姑息治疗和止痛权威委员会的权重，识别存在姑息治疗需求的死亡者和非死亡者。预计到2021年，智利需要姑息治疗的人数为11.7万（95% CI 11.4万至12万），到2050年将增加至20.9万（95% CI 19.8万至22.3万），增长79%（IRR 1.79；95% CI 1.78-1.80）。这一增长主要由非癌症疾病驱动，尤其是痴呆（IRR 2.9，95% CI 2.85-2.95）和心血管疾病（IRR 1.86，95% CI 1.83-1.89）。到2050年，预计需要姑息治疗的人群中，非死亡者将占50%（预计一年内不会死亡）。智利的姑息治疗需求将大幅增加，尤其是痴呆和其他非癌症疾病患者。为实现全民可及的高质量服务，亟需扩大医务人员培训和创新可持续的护理模式。

Abstract

The number of people with palliative care needs is projected to increase globally. Chile has recently introduced legislation for universal access to palliative care services for patients with severe and terminal illnesses, including non-cancer conditions. We aimed to estimate the number of people affected by serious health-related suffering and need for palliative care in Chile to 2050.We used data on all deaths registered in Chile between 1997-2019 and population estimates for 1997-2050. We used Poisson regression to model past trends in causes of death adjusted by age, sex and population estimates, to project the number of deaths for each cause from 2021 to 2050. We applied the Lancet Commission on Palliative Care and Pain Relief weights to these projections to identify decedents and non-decedents with palliative care needs.Population palliative care needs in Chile are projected to increase from 117 (95% CI 114 to 120) thousand people in 2021 to 209 (95% CI 198 to 223) thousand people in 2050, a 79% increase (IRR 1.79; 95% CI 1.78-1.80). This increase will be driven by non-cancer conditions, particularly dementia (IRR 2.9, 95% CI 2.85-2.95) and cardiovascular conditions (IRR 1.86, 95% CI 1.83-1.89). By 2050, 50% of those estimated to need palliative care will be non-decedents (not expected to die within a year).Chile will experience a large increase in palliative care needs, particularly for people with dementia and other non-cancer conditions. Improved availability of high-quality services, expanded clinician training and new sustainable models of care are urgently required to ensure universal access to palliative care.