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Association of rurality, type of primary caregiver and place of death with end-of-life medical expenditures among the oldest-old population in China

BACKGROUND: Understanding whether the type of primary caregiver and end-of-life (EOL) care location are associated with EOL medical expenditures is crucial to inform global debates on policies for efficient and effective EOL care. This study aims to assess trends in the type of primary caregiver and...

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Autores principales: Li, Zhong, Hung, Peiyin, Shi, Kewei, Fu, You, Qian, Dongfu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9809123/
https://www.ncbi.nlm.nih.gov/pubmed/36597134
http://dx.doi.org/10.1186/s12939-022-01813-2
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author Li, Zhong
Hung, Peiyin
Shi, Kewei
Fu, You
Qian, Dongfu
author_facet Li, Zhong
Hung, Peiyin
Shi, Kewei
Fu, You
Qian, Dongfu
author_sort Li, Zhong
collection PubMed
description BACKGROUND: Understanding whether the type of primary caregiver and end-of-life (EOL) care location are associated with EOL medical expenditures is crucial to inform global debates on policies for efficient and effective EOL care. This study aims to assess trends in the type of primary caregiver and place of death stratified by rural‒urban status among the oldest-old population from 1998–2018 in China. A secondary objective is to determine the associations between rurality, the type of primary caregiver, place of death and EOL medical expenditures.  METHODS: A total of 20,149 deaths of people aged 80 years or older were derived from the Chinese Longitudinal Health Longevity Survey (CLHLS). Cochran-Armitage tests and Cuzick’s tests were used to test trends in the type of primary caregiver and place of death over time, respectively. Tobit models were used to estimate the marginal associations of rurality, type of primary caregiver, and place of death with EOL medical expenditures because CLHLS sets 100,000 Chinese yuan (approximately US$15,286) as the upper limit of the outcome variable.  RESULTS: Of the 20,149 oldest-old people, the median age at death was 97 years old, 12,490 (weighted, 58.6%, hereafter) were female, and 8,235 lived in urban areas. From 1998–2018, the prevalence of informal caregivers significantly increased from 94.3% to 96.2%, and home death significantly increased from 86.0% to 89.5%. The proportion of people receiving help from informal caregivers significantly increased in urban decedents (16.5%) but decreased in rural decedents (-4.0%), while home death rates significantly increased among both urban (15.3%) and rural (1.8%) decedents. In the adjusted models, rural decedents spent less than urban decedents did (marginal difference [95% CI]: $-229 [$-378, $-80]). Those who died in hospitals spent more than those who died at home ($798 [$518, $1077]). No difference in medical expenditures by type of primary caregiver was observed. CONCLUSIONS: Over the past two decades, the increases in informal caregiver utilization and home deaths were unequal, leading to substantially higher EOL medical expenditures among urban decedents and deceased individuals who died at hospitals than among their counterparts who lived in rural areas and died at home. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12939-022-01813-2.
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spelling pubmed-98091232023-01-04 Association of rurality, type of primary caregiver and place of death with end-of-life medical expenditures among the oldest-old population in China Li, Zhong Hung, Peiyin Shi, Kewei Fu, You Qian, Dongfu Int J Equity Health Research BACKGROUND: Understanding whether the type of primary caregiver and end-of-life (EOL) care location are associated with EOL medical expenditures is crucial to inform global debates on policies for efficient and effective EOL care. This study aims to assess trends in the type of primary caregiver and place of death stratified by rural‒urban status among the oldest-old population from 1998–2018 in China. A secondary objective is to determine the associations between rurality, the type of primary caregiver, place of death and EOL medical expenditures.  METHODS: A total of 20,149 deaths of people aged 80 years or older were derived from the Chinese Longitudinal Health Longevity Survey (CLHLS). Cochran-Armitage tests and Cuzick’s tests were used to test trends in the type of primary caregiver and place of death over time, respectively. Tobit models were used to estimate the marginal associations of rurality, type of primary caregiver, and place of death with EOL medical expenditures because CLHLS sets 100,000 Chinese yuan (approximately US$15,286) as the upper limit of the outcome variable.  RESULTS: Of the 20,149 oldest-old people, the median age at death was 97 years old, 12,490 (weighted, 58.6%, hereafter) were female, and 8,235 lived in urban areas. From 1998–2018, the prevalence of informal caregivers significantly increased from 94.3% to 96.2%, and home death significantly increased from 86.0% to 89.5%. The proportion of people receiving help from informal caregivers significantly increased in urban decedents (16.5%) but decreased in rural decedents (-4.0%), while home death rates significantly increased among both urban (15.3%) and rural (1.8%) decedents. In the adjusted models, rural decedents spent less than urban decedents did (marginal difference [95% CI]: $-229 [$-378, $-80]). Those who died in hospitals spent more than those who died at home ($798 [$518, $1077]). No difference in medical expenditures by type of primary caregiver was observed. CONCLUSIONS: Over the past two decades, the increases in informal caregiver utilization and home deaths were unequal, leading to substantially higher EOL medical expenditures among urban decedents and deceased individuals who died at hospitals than among their counterparts who lived in rural areas and died at home. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12939-022-01813-2. BioMed Central 2023-01-03 /pmc/articles/PMC9809123/ /pubmed/36597134 http://dx.doi.org/10.1186/s12939-022-01813-2 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Li, Zhong
Hung, Peiyin
Shi, Kewei
Fu, You
Qian, Dongfu
Association of rurality, type of primary caregiver and place of death with end-of-life medical expenditures among the oldest-old population in China
title Association of rurality, type of primary caregiver and place of death with end-of-life medical expenditures among the oldest-old population in China
title_full Association of rurality, type of primary caregiver and place of death with end-of-life medical expenditures among the oldest-old population in China
title_fullStr Association of rurality, type of primary caregiver and place of death with end-of-life medical expenditures among the oldest-old population in China
title_full_unstemmed Association of rurality, type of primary caregiver and place of death with end-of-life medical expenditures among the oldest-old population in China
title_short Association of rurality, type of primary caregiver and place of death with end-of-life medical expenditures among the oldest-old population in China
title_sort association of rurality, type of primary caregiver and place of death with end-of-life medical expenditures among the oldest-old population in china
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9809123/
https://www.ncbi.nlm.nih.gov/pubmed/36597134
http://dx.doi.org/10.1186/s12939-022-01813-2
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