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2014—2023年湖南省居民临终地点及变化趋势：基于死因监测资料的分析

Places of death and changing trends of residents in Hunan province from 2014 to 2023: an analysis based on cause-of-death surveillance data

    摘要
  • 摘要:
    目的  分析2014—2023年湖南省居民临终地点变化趋势，为构建符合国情的临终关怀服务体系提供实证依据。
    方法 收集2014—2023年湖南省死因监测数据，以2020年湖南省人口普查数据为标准人口，计算经年龄标准化的临终地点构成比，采用Joinpoint回归模型分析不同临终地点的变化趋势。
    结果 2014—2023年，湖南省登记死亡人口中居家临终占比81.18%、年均上升0.40%（AAPC=0.40%，P<0.001）；医疗机构临终构成比呈现先降（2014—2017年APC= −2.49%，P=0.020）后升（2017—2023年APC=1.55%，P<0.001）；养老机构临终构成比年均增长8.59%（AAPC=8.59%，P<0.001）；来院途中临终构成比年均下降4.32%（AAPC= −4.32%，P<0.001）。2014—2023年，湖南省医疗机构临终构成比农村（8.52%）与城市（19.69%）比较差异有统计学意义（χ2=106 862.300，P<0.001），农村医疗机构临终构成比年均上升1.31%（AAPC=1.31%，P<0.001）。
    结论 湖南省临终地点仍以居家为主，但医疗机构和养老机构占比快速上升，呈现机构化转型趋势。未来政策需平衡“资源公平”与“文化适配”，在提升医疗可及性的同时维护临终选择的多样性与尊严。

     

    Abstract:
    Objective  To understand the changing trends of places of death among residents in Hunan province from 2014 to 2023 and provide an empirical basis for constructing a hospice care service system in line with national conditions.
    Methods The cause-of-death surveillance data of Hunan province from 2014 to 2023 were collected. The 2020 Hunan census data were taken as the standard population to calculate the age-standardized composition ratio of the places of death. The Joinpoint regression model was adopted to analyze the changing trend of different places of death.
    Results From 2014 to 2023, 81.18% of the registered deaths in Hunan province were dying at home, with an average annual increase of 0.40% (AAPC = 0.40%, P < 0.001). The ratio of death in hospitals first decreased (2014–2017: APC =–2.49%, P = 0.020) and then increased (2017–2023: APC = 1.55%, P < 0.001). The ratio of death in nursing institutions increased by 8.59% annually (AAPC = 8.59%, P < 0.001). The ratio of death on the way to hospitals decreased by 4.32% annually (AAPC = –4.32%, P < 0.001). From 2014 to 2023, the ratio of death in rural hospitals in Hunan province was 8.52%, which differed from that (19.69%) in urban hospitals (χ2 = 106 862.300, P < 0.001). The ratio of death in rural hospitals increased by 1.31% annually (AAPC = 1.31%, P < 0.001).
    Conclusions Home is still the dominated place of death in Hunan province, while the ratios of death in hospitals and nursing institutions are rising rapidly. Future policies should balance resource equity and cultural adaptation and improve medical access while maintaining the diversity and dignity of end-of-life choices.

     

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