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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Where do children with complex chronic conditions die? Patterns in Washington State, 1980-1998.
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Where do children with complex chronic conditions die? Patterns in Washington State, 1980-1998.

机译：患有慢性疾病的儿童在哪里死亡？华盛顿州的模式，1980-1998年。

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OBJECTIVE: Little is known about factors that influence whether children with chronic conditions die at home. We sought to test whether deaths attributable to underlying complex chronic conditions (CCCs) were increasingly occurring at home and to determine what features were associated with home deaths. DESIGN: A retrospective case series was conducted of all deaths that occurred to children age 0 to 18 years in Washington state from 1980 to 1998 using death certificate data, augmented with 1990 US Census data regarding median household income by zip code in 1989, to determine the site of death. RESULTS: Of the 31 455 deaths identified in infants, children, and adults younger than 25 years, 52% occurred in the hospital, 17.2% occurred at home, 8.5% occurred in the emergency department or during transportation, 0.4% occurred in nursing homes, and 21.7% occurred at other sites. Among children who died as a result of some form of CCC (excluding injury, sudden infant death syndrome, and non-CCC medical conditions), the percentage of cases younger than 1 year who died at home rose slightly from 7.8% in 1980 to 11.6% in 1998, whereas the percentage of older children and young adults who had a CCC and died at home rose substantially from 21% in 1980 to 43% in 1998. Children who had lived in more affluent neighborhoods were more likely to have died at home. Using leukemia-related deaths as a benchmark, deaths as a result of congenital, genetic, neuromuscular, and metabolic conditions and other forms of cancer all were more likely to have occurred at home. Significant variation in the likelihood of home death, not explained by the individual attributes of the cases, also existed across the 39 counties in Washington state. CONCLUSIONS: Children who die with underlying CCCs increasingly do so at home. Age at death, specific condition, local area affluence, and the location of home all influence the likelihood of home death. These findings warrant additional study, as they have implications for how we envision pediatric palliative care, hospice, and other supportive services for the future.
机译：目的：影响慢性病儿童是否在家中死亡的因素知之甚少。我们试图测试是否由于家庭潜在的复杂慢性病（CCC）导致的死亡人数越来越多，并确定与家庭死亡有关的特征。设计：使用死亡证明书数据对华盛顿州1980年至1998年发生的所有0至18岁儿童死亡案例进行回顾性病例系列分析，并以1989年的美国邮政编码数据（以1989年的邮政编码为基础的1990年美国人口普查数据）进行补充，以确定死亡地点。结果：在确定的31 455例婴儿，儿童和25岁以下的成年人死亡中，有52％发生在医院，17.2％在家中，8.5％发生在急诊室或在运输期间，0.4％发生在疗养院中，其他网站发生了21.7％。在因某种形式的CCC而死亡的儿童中（不包括受伤，婴儿猝死综合症和非CCC医疗状况），在家中死亡的1岁以下病例所占的百分比从1980年的7.8％略微上升到11.6％ 1998年的百分比，而患有CCC并在家中死亡的年龄较大的儿童和年轻人的百分比从1980年的21％大幅上升至1998年的43％。生活在较富裕社区中的儿童更有可能在家中死亡。以与白血病相关的死亡为基准，由于先天性，遗传性，神经肌肉性，代谢性疾病以及其他形式的癌症而导致的死亡都更有可能在家中发生。华盛顿州的39个县中也存在家庭死亡可能性的显着差异，但案件的个别属性无法解释。结论：死于潜在CCC的儿童越来越多地在家中死亡。死亡年龄，特定条件，当地富裕程度以及房屋位置都影响房屋死亡的可能性。这些发现值得进一步研究，因为它们对我们对未来的儿科姑息治疗，临终关怀和其他支持服务的构想具有影响。

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