尽管神经退行性疾病是死亡的主要原因，但人们对临终 (EoL) 期间医疗保健的利用和费用以及与其他生命限制疾病的比较如何了解甚少。我们的目的是描述和比较患有神经退行性疾病的美国医疗保险死者和患有癌症的死者的资源利用情况。我们对患有阿尔茨海默病 (AD)、帕金森病 (PD) 或肌萎缩侧索硬化症的医疗保险 A 部分和 B 部分受益人进行了回顾性研究。 ALS）于 2018 年去世。被诊断患有恶性脑肿瘤或胰腺癌的死者作为非神经退行性比较者。描述性分析检查了生命最后一年的人口统计和临床特征。还比较了神经退行性疾病和癌症患者在生命最后 12 个月和 6 个月内使用急诊科 (ED)、住院、熟练护理设施 (SNF) 和临终关怀中心的概率和相关费用，并调整了社会人口因素和合并症2018 年，共有 1,126,799 名医疗保险受益人死亡，其中 357,926 人有合格诊断。与患有脑癌或胰腺癌的人相比，患有神经退行性疾病的人年龄更大，并且更频繁地接受医疗补助援助。在所有群体中，医疗保健服务的利用率在生命的最后一年有所增加，总成本主要归因于住院护理。在生命的最后 6 个月，神经退行性疾病患者很少接受神经科医师护理（AD：1.5%；PD：8.6%；ALS：32.0%）。与患有恶性脑肿瘤的人相比，患有神经退行性疾病的人使用 ED 的几率也更大（AD：调整后的比值比 [aOR] 1.17，95% CI 1.11-1.23；PD：aOR 1.18，95% CI 1.11-1.25；ALS ：aOR 1.11，95% CI 1.01-1.23），住院几率较低（AD：aOR 0.64，95% CI 0.60-0.68；PD：aOR 0.65，95% CI 0.61-0.69；ALS：aOR 0.33，95% CI 0.30 -0.37），入院临终关怀的几率较低（AD：aOR 0.33，95% CI 0.31-0.36；PD：aOR 0.33，95% CI 0.31-0.36；ALS：aOR 0.41，95% CI 0.36-0.46）。胰腺癌的研究结果相似。与脑癌或胰腺癌患者相比，美国患有神经退行性疾病的患者更有可能去急诊室就诊，而在临终关怀中心使用住院和临终关怀服务的可能性较小。这些群体差异可能源于预后的不确定性，并反映出临终关怀实践不足，需要进一步调查以确保更及时的姑息治疗和临终关怀转诊。

Although neurodegenerative diseases are a leading cause of death, little is known about health care utilization and cost during the end-of-life (EoL) period or how it compares with that of other life-limiting conditions. We aimed to describe and compare resource utilization among US Medicare decedents with neurodegenerative diseases with decedents with cancer.We conducted a retrospective study of Medicare Part A and B beneficiaries with Alzheimer disease (AD), Parkinson disease (PD), or amyotrophic lateral sclerosis (ALS) who died in 2018. Decedents diagnosed with malignant brain tumors or pancreatic cancer served as non-neurodegenerative comparators. Descriptive analyses examined demographic and clinical characteristics in the last year of life. The probabilities and associated costs of emergency department (ED), inpatient, skilled nursing facility (SNF), and hospice utilization during the last 12 and 6 months of life were also compared between persons with neurodegenerative diseases and cancer, adjusting for sociodemographic factors and comorbidity burden.A total of 1,126,799 Medicare beneficiaries died in 2018, of which 357,926 had a qualifying diagnosis. Persons with neurodegenerative diseases were older and more frequently received Medicaid assistance than persons with brain or pancreatic cancer. In all groups, health care service utilization increased over the last year of life, and total costs were predominantly attributable to inpatient care. In the last 6 months of life, neurologist care was infrequent among patients with neurodegenerative disease (AD: 1.5%; PD: 8.6%; ALS: 32.0%). Persons with neurodegenerative diseases as compared to persons with malignant brain tumors also had greater odds of ED use (AD: adjusted odds ratio [aOR] 1.17, 95% CI 1.11-1.23; PD: aOR 1.18, 95% CI 1.11-1.25; ALS: aOR 1.11, 95% CI 1.01-1.23), lower odds of hospitalization (AD: aOR 0.64, 95% CI 0.60-0.68; PD: aOR 0.65, 95% CI 0.61-0.69; ALS: aOR 0.33, 95% CI 0.30-0.37), and lower odds of hospice enrollment (AD: aOR 0.33, 95% CI 0.31-0.36; PD: aOR 0.33, 95% CI 0.31-0.36; ALS: aOR 0.41, 95% CI 0.36-0.46). The findings were similar in pancreatic cancer.Persons with neurodegenerative diseases in the United States are more likely to visit the ED and less likely to use inpatient and hospice services at EoL than persons with brain or pancreatic cancer. These group differences may stem from prognostic uncertainty and reflect inadequate EoL care practices, requiring further investigation to ensure more timely palliative care and hospice referrals.