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. 2022 Feb 2:21:100383.
doi: 10.1016/j.lanwpc.2022.100383. eCollection 2022 Apr.

Trends and associated factors in place of death among individuals with cardiovascular disease in China, 2008-2020: A population-based study

Wei Wang  1 , Yunning Liu  1 , Pengpeng Ye  1 , Jiangmei Liu  1 , Peng Yin  1 , Jinlei Qi  1 , Jinling You  1 , Lin Lin  1 , Feixue Wang  1 , Lijun Wang  1 , Yong Huo  2 , Maigeng Zhou  1
Affiliations

Trends and associated factors in place of death among individuals with cardiovascular disease in China, 2008-2020: A population-based study

Wei Wang et al. Lancet Reg Health West Pac. .

Abstract

Background: Cardiovascular disease (CVD) is the leading cause of death (COD) in China. Understanding the characteristics of place of death (POD) among CVD deaths would be of great importance to evaluate the healthcare service utilization at the end stage of life. Limited studies have reported the POD distribution among CVD deaths, and little was known about the associated factors of hospital CVD deaths.

Methods: By using data from National Mortality Surveillance System (NMSS) in China, this study presented the characteristics of POD distribution during 2008 and 2020. Afterwards, multilevel logistic regression was used to explore associated factors of hospital CVD deaths and quantify the magnitude to which the spatial variations of hospital CVD deaths could be explained by those associated factors.

Findings: During 2008-2020, there was 7101871 CVD deaths collected by NMSS in China, with 77·13% home deaths and 18·49% hospital deaths. Shanghai (59·40%) had the highest percentage of hospital CVD deaths. Age, sex, ethnicity, marital status, education, occupation, underlying COD were significant influential factors of hospital CVD deaths. Spatial variations were shown at provincial level, with 33·88% of them being explained by factors at individual level.

Interpretation: Home was the leading POD among CVD deaths in China, those CVD decedents characterized as the female, the youngest, Han population, the married, the retiree, lived in urban areas, with higher socioeconomic status and died of chronic CVDs had a higher probability of hospital deaths. Providing accessible and available healthcare services were priorities to improve quality of end-of-life care, significant variations among provinces and sub-population also reminded us of the requirements for equal healthcare resources allocation and multiple options for minorities of POD preference at the end stage of life.

Funding: National Key Research & Development Program of China (grant number 2018YFC1315301).

Keywords: Associated factors; Cardiovascular disease; China; Place of death; Spatial variations; Trends.

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Conflict of interest statement

This research was supported by the National Key Research & Development Program of China (grant number 2018YFC1315301). The funders of the study have no role in study design, data collection, data analysis, data interpretation, or writing of the report. Thus, there are no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Percentage of POD distribution among CVD deaths from NMSS in China, by sex. (A) Percentage of POD among CVD deaths in China, 2008-2020; (B) Percentage of POD among CVD deaths in China, by age, 2020; (C) Percentage of POD among CVD deaths in China, by CVD subcategories, 2020; (D) Percentage of POD among CVD deaths in China, by province, 2020.
Figure 2
Figure 2
Percentage of POD distribution among CVD deaths from NMSS in China, by rurality status. (A) Percentage of POD among CVD deaths in China, 2008-2020; (B) Percentage of POD among CVD deaths in China, by age, 2020; (C) Percentage of POD among CVD deaths in China, by CVD subcategories, 2020; (D) Percentage of POD among CVD deaths in China, by province, 2020.
Figure 3
Figure 3
Associated factors of hospital IHD and stroke deaths in China, 2008-2020: estimated from multilevel logistics regression (A) Ischemic heart disease; (B) Stroke. Abbreviations: OR, odds ratio; CI, confidence interval; Q1, 1st quantile; Q2, 2nd quantile; Q3, 3rd quantile; Q4, 4th quantile a *P<0.05. b Region: Western: Inner Mongolia, Guangxi, Chongqing, Sichuan, Guizhou, Yunnan, Tibet, Shaanxi, Gansu, Qinghai, Ningxia, Xinjiang; Central: Shanxi, Jilin, Heilongjiang, Anhui, Jiangxi, Henan, Hubei, Hunan; Eastern: Beijing, Tianjin, Hebei, Liaoning, Shanghai, Jiangsu, Zhejiang, Fujian, Shandong, Guangdong, Hainan.
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References

    1. National Center for Cardiovascular Diseases, China . Encyclopedia of China Publishing House; Beijing: 2019. Report on Cardiovascular Diseases in China 2018.
    1. Institution of Health Metrics and Evaluation. GBD results tool [EB/OL]. http://ghdx.healthdata.org/gbd-results-tool. Accessed 8 December 2021
    1. Zhao D, Liu J, Wang M, Zhang X, Zhou M. Epidemiology of cardiovascular disease in China: Current features and implications. Nat Rev Cardiol. 2019;16(4):203–212. - PubMed
    1. Danan G, Guangya L, Denese AV, Zeng Y. Factors associated with place of death among the Chinese oldest old. J Appl Gerontol. 2007;26(1):34–57.
    1. Gao W, Ho YK, Verne J, Glickman M, Higginson IJ. Changing patterns in place of cancer death in England: A population-based study. PloS Med. 2013;10(3) - PMC - PubMed

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