影響臺灣死亡地點的臨床與心理社會因子

Psychosocial and Clinical Factors Associated with Place of Death in Taiwan

朱思盈(Szu-Ying Chu) ； 林明慧(Ming-Hwai Lin) ； 陳曾基(Tzeng-Ji Chen) ； 黃信彰(Shinn-Jang Hwang)

《北市醫學雜誌》 5卷5期 (2008/10) Pp. 484-494

https://doi.org/10.6200/TCMJ.2008.5.5.02

摘要

目的：國內外探討善終的相關文獻均指出，病人最終死亡處所與生命末期臨終照護品質息息相關。臺灣傳統民俗尤其重視在自宅死亡，然，臺灣地區住民的死亡處所（醫院或自宅）迄今少有詳盡統計分析。本研究藉由分析本國死因資料檔，呈現近年國人死亡地點的趨勢，嘗試分析其相關影響因素，以供臨終病人照顧品質提升方案研擬時參考。方法：本研究資料來源為1981年起至2004年止衛生署全國死因統計資料檔。本研究將死亡地點區分為「在自宅死亡」、「在醫院或診所死亡」及「在其他地點死亡」三類，以描述性統計方式進行交叉分析，以邏輯迴歸分析(logistic regression analysis)計算不同變項的機會比(odds ratio, OR)。結果：二十四年期間共有2620284筆死亡資料，其中在自宅死亡者為1546194人（佔59.0%），在醫院或診所死亡者為854336人(32.6%)，在其他地點死亡者為219754人(8.4%)。女性自宅死亡比率明顯高於男性(67.7% vs. 53.6%；OR=1.817)。「已婚」、「離婚」及「配偶死亡」者自宅死亡比率分別為61.5%、38.5%及75.7%，明顯高於「未婚」者的28.0%（OR=4.112、OR=1.607及OR=8.007）。自宅死亡之比率隨死亡時的年齡增加呈逐漸增加趨勢（小於1歲組為25.1%，大於90歲組為77.0%，OR=9.990）。此外，自宅死亡比率於近年呈現逐年遞減（1981年：60.1% vs. 2004年：54.8%）。死亡者戶籍位於都會區的自宅死亡年平均率也較低（台北市34.6% vs.雲林縣76.0%）。主要死因為「支氣管炎、肺氣腫及氣喘」的住民在自宅死亡比率最高(76.2%)，主要死因為「事故傷害」的住民在自宅死亡比率最低(22.3%)。結論：影響臺灣地區住民死亡地點之因素，包括性別、死亡年齡、婚姻狀況、戶籍、死亡年代、主要死因診斷等。

關鍵字

死亡統計 ； 死亡地點 ； 臨終照顧 ； 居家照顧

並列摘要

Objectives: Although many patients with terminal illness prefer to die at home, the wish might not be fulfilled all the time. Our study analyzed the death datasets claimed officially to provide more information for the policy on improving the home care to the dying people in the community. Methods: The study was to describe the annual trends and associated factors of the places of death between 1981 and 2004 in Taiwan. The datasets of causes of death for all people in Taiwan were included into analysis. Logistic regression analysis was used to identify the odds of dying at home over time and the predictive factors of home death. Results: A total of 2620284 people died during the study period. Women were more likely to die at home than men (67.0% vs. 53.6%). People tended to die at home with an increasing age (77.0% in age ＞ 90 vs. 25.1% in age ＜ 1 year). The annual percentage of home death of the whole nation decreased from 60.1% in 1981 to 54.8% in 2004. The decreasing trend was also observed in metropolitan areas. While people with the major death cause of bronchitis, emphysema and asthma had the highest percentage of home death (76.2%), those who died of accidents had the lowest percentage (22.3%). Conclusions: The predicting factors for home death included gender, age at death, marital status, county of residence, year of death, and cause of death.

並列關鍵字

death certificates ； place of death ； end-of-life care ； home care