Regional Variation in End-of-life Care Just Before Death Among the Oldest Old in Japan: A Descriptive Study
Background: The use of life-sustaining treatment (LST) in the final stage of life is a major policy concern due to increased costs, while its intensity does not correlate with quality. Previous reports have shown declining trends in LST use in Japan. However, regional practice variations remain uncl...
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Japan Epidemiological Association
2024-12-01
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| Series: | Journal of Epidemiology |
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| Online Access: | https://www.jstage.jst.go.jp/article/jea/34/12/34_JE20230364/_pdf |
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| author | Michi Sakai Naohiro Mitsutake Tomohide Iwao Genta Kato Shuzo Nishimura Takeo Nakayama |
| author_facet | Michi Sakai Naohiro Mitsutake Tomohide Iwao Genta Kato Shuzo Nishimura Takeo Nakayama |
| author_sort | Michi Sakai |
| collection | DOAJ |
| description | Background: The use of life-sustaining treatment (LST) in the final stage of life is a major policy concern due to increased costs, while its intensity does not correlate with quality. Previous reports have shown declining trends in LST use in Japan. However, regional practice variations remain unclear. This study aims to describe regional variations in LST use before death among the oldest old in Japan. Methods: A descriptive study was conducted among patients aged 85 years or older who passed away between April 2013 and March 2014. The study utilized health insurance claims from Japan’s National Database (NDB) to examine the use of cardiopulmonary resuscitation (CPR), mechanical ventilation (MV), and admission to the acute care ward (ACW) in the last 7 days of life. Results: Among 224,391 patients, the proportion of patients receiving LST varied by region. CPR ranged from 8.6% (Chubu) to 12.9% (Shikoku), MV ranged from 7.1% (Chubu) to 12.3% (Shikoku), and admission to ACW ranged from 4.5% (Chubu) to 10.1% (Kyushu-Okinawa). The adjusted odds ratios (AOR) for regional variation compared with Kanto were as follows: CPR (in Shikoku, AOR 1.85; 95% confidence interval [CI], 1.73–1.98), MV (in Shikoku, AOR 1.75; 95% CI, 1.63–1.87), and ACW admission (in Kyushu-Okinawa, AOR 1.69; 95% CI, 1.52–1.88). Conclusion: The study presents descriptive information regarding regional differences in the utilization of LST for the oldest old in Japan. Further research is necessary to identify the factors that contribute to these variations and to address the challenge of improving the quality of end-of-life care. |
| format | Article |
| id | doaj-art-adcc076e44c948b9a8e260e11a4a137f |
| institution | OA Journals |
| issn | 0917-5040 1349-9092 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Japan Epidemiological Association |
| record_format | Article |
| series | Journal of Epidemiology |
| spelling | doaj-art-adcc076e44c948b9a8e260e11a4a137f2025-08-20T02:36:03ZengJapan Epidemiological AssociationJournal of Epidemiology0917-50401349-90922024-12-01341260060410.2188/jea.JE20230364Regional Variation in End-of-life Care Just Before Death Among the Oldest Old in Japan: A Descriptive StudyMichi Sakai0Naohiro Mitsutake1Tomohide Iwao2Genta Kato3Shuzo Nishimura4Takeo Nakayama5Department of Health Informatics, Kyoto University School of Medicine and Public Health, Kyoto, JapanDepartment of Research, Institute for Health Economics and Policy (IHEP), Tokyo, JapanInstitute for Advancement of Clinical and Translational Science (iACT), Kyoto University Hospital, Kyoto, JapanSolution Center for Health Insurance Claims, Kyoto University Hospital, Kyoto, JapanKyoto University Graduate School, Kyoto, JapanDepartment of Health Informatics, Kyoto University School of Medicine and Public Health, Kyoto, JapanBackground: The use of life-sustaining treatment (LST) in the final stage of life is a major policy concern due to increased costs, while its intensity does not correlate with quality. Previous reports have shown declining trends in LST use in Japan. However, regional practice variations remain unclear. This study aims to describe regional variations in LST use before death among the oldest old in Japan. Methods: A descriptive study was conducted among patients aged 85 years or older who passed away between April 2013 and March 2014. The study utilized health insurance claims from Japan’s National Database (NDB) to examine the use of cardiopulmonary resuscitation (CPR), mechanical ventilation (MV), and admission to the acute care ward (ACW) in the last 7 days of life. Results: Among 224,391 patients, the proportion of patients receiving LST varied by region. CPR ranged from 8.6% (Chubu) to 12.9% (Shikoku), MV ranged from 7.1% (Chubu) to 12.3% (Shikoku), and admission to ACW ranged from 4.5% (Chubu) to 10.1% (Kyushu-Okinawa). The adjusted odds ratios (AOR) for regional variation compared with Kanto were as follows: CPR (in Shikoku, AOR 1.85; 95% confidence interval [CI], 1.73–1.98), MV (in Shikoku, AOR 1.75; 95% CI, 1.63–1.87), and ACW admission (in Kyushu-Okinawa, AOR 1.69; 95% CI, 1.52–1.88). Conclusion: The study presents descriptive information regarding regional differences in the utilization of LST for the oldest old in Japan. Further research is necessary to identify the factors that contribute to these variations and to address the challenge of improving the quality of end-of-life care.https://www.jstage.jst.go.jp/article/jea/34/12/34_JE20230364/_pdfthe oldest oldhealth insurance claimsreal-world dataend-of-life care |
| spellingShingle | Michi Sakai Naohiro Mitsutake Tomohide Iwao Genta Kato Shuzo Nishimura Takeo Nakayama Regional Variation in End-of-life Care Just Before Death Among the Oldest Old in Japan: A Descriptive Study Journal of Epidemiology the oldest old health insurance claims real-world data end-of-life care |
| title | Regional Variation in End-of-life Care Just Before Death Among the Oldest Old in Japan: A Descriptive Study |
| title_full | Regional Variation in End-of-life Care Just Before Death Among the Oldest Old in Japan: A Descriptive Study |
| title_fullStr | Regional Variation in End-of-life Care Just Before Death Among the Oldest Old in Japan: A Descriptive Study |
| title_full_unstemmed | Regional Variation in End-of-life Care Just Before Death Among the Oldest Old in Japan: A Descriptive Study |
| title_short | Regional Variation in End-of-life Care Just Before Death Among the Oldest Old in Japan: A Descriptive Study |
| title_sort | regional variation in end of life care just before death among the oldest old in japan a descriptive study |
| topic | the oldest old health insurance claims real-world data end-of-life care |
| url | https://www.jstage.jst.go.jp/article/jea/34/12/34_JE20230364/_pdf |
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