Hospital death in dementia patients and regional provision of palliative and end-of-life care: National patient data analysis

Figures & data

Table 1. Patient characteristics (N = 12,933)

	n (%)
Sex, male	5,555 (43.0)
Age (years)	Mean (SD), 82.0 (8.3)
Length of hospital stay (days)	Mean (SD), 160.0 (204.8)
Assessment year
2008	4,001 (30.9)
2011	4,386 (33.9)
2014	4,546 (35.2)
Dementia type
Alzheimer’s disease	7,030 (54.3)
Vascular	2,026 (15.6)
Unspecified	3,877 (30.0)
Comorbidities
Diabetes	1,720 (13.3)
Hypertension	4, 070 (31.5)
Ischemic cardiac disease	1,009 (7.8)
Stroke	991 (7.7)
Chronic renal failure	408 (3.2)
Previous care location
Home	7,220 (55.8)
Facility	3,533 (27.3)
Hospital	2,180 (16.9)
Type of care provided
Psychiatric	10,371 (64.1)
Long-term	2,562 (15.8)
Discharge destination
Home	3,940 (30.5)
Hospital	3,055 (23.6)
Facility	3,279 (25.4)
Death in hospital	2,659 (20.6)
Distance from the hospital to patient’s residence
Same secondary medical area	10,010 (77.4)
Same municipality	6,703 (51.8)
Same prefecture	12,265 (94.8)
Number of beds in specialized nursing homes per 1,000 population
<25th percentile	1,461 (11.4)
25–75th percentiles	6,540 (51.2)
>75th percentile	4,770 (37.4)
Number of patients covered by home-based care support clinics per 1,000 population
<25th percentile	1,879 (14.7)
25–75th percentiles	6,561 (51.4)
>75th percentile	4,331 (33.9)

Table 2. Multinomial logistic regression analysis of discharge outcomes for dementia patients

	Hospital admission		Facility admission		Death in hospital
	Odds ratio (95% CI)	p value	Odds ratio (95% CI)	p value	Odds ratio (95% CI)	p value
Number of patients covered by home-based care support clinics per 1,000 population (>75th percentile = 0)
<25th percentile	0.88 (0.73–1.06)	0.187	0.89 (0.74–1.08)	0.239	0.78 (0.63–0.96)	.031
25–75th percentiles	0.88 (0.77–1.00)	0.062	0.95 (0.83–1.09)	0.489	0.95 (0.82–1.11)	.522
Number of beds in specialized nursing homes per 1,000 population (>75th percentile = 0)
<25th percentile	0.97 (0.77–1.20)	.747	1.07(0.86–1.33)	.551	0.93 (0.73–1.19)	.563
25–75th percentiles	0.95 (0.82–1.10)	.479	0.94 (0.81–1.09)	.422	0.83 (0.70–0.98)	.031
Age	1.02 (1.02–1.03)	<.001	1.03 (1.02–1.03)	<.001	1.09 (1.08–1.10)	<.001
Duration of hospitalization	1.48 (1.43–1.54)	<.001	1.73 (1.66–1.80)	<.001	2.18 (2.07–2.28)	<.001
Sex, male	0.59 (0.53–0.66)	<.001	0.87 (0.78–0.98)	.017	0.38 (0.33–0.43)	<.001
Assessment year (2008 = 0)
2011	0.96 (0.78–1.06)	.675	0.98 (0.80–1.2)	.854	0.67 (0.53–0.84)	.001
2014	1.18 (1.03–1.36)	.017	0.91 (0.79–1.04)	.165	0.77 (0.66–0.90)	<.001
Comorbidities
Diabetes	0.91 (0.78–1.06)	.209	0.95 (0.81–1.11)	.484	0.86 (0.72–1.03)	.103
Hypertension	1.24 (1.10–1.39)	<.001	1.07 (0.96–1.2)	.240	1.53 (1.34–1.74)	<.001
Stroke	1.04 (0.84–1.28)	.719	0.92 (0.74–1.13)	.403	0.91 (0.72–1.13)	.384
Distance of hospital to patient’s residence
Same prefecture	1.11 (0.84–1.49)	.465	0.97 (0.72–1.13)	.814	1.44 (1.05–2.0)	.023
Same secondary medical area	1.01 (0.86–1.19)	.918	0.988 (0.839–1.164)	.887	0.98 (0.82–1.18)	.850
Same municipality	1.08 (0.96–1.23)	.216	1.16 (1.02–1.32)	.021	1.10(0.96–1.27)	.181
Previous care location
Facility	0.12 (0.11–0.14)	<.001	0.27 (0.23–0.31)	<.001	0.11 (0.09–0.13)	<.001
Hospital	0.13 (0.10–0.16)	<.001	0.04 (0.03–0.05)	<.001	0.06 (0.05–0.07)	<.001
Type of care provided (psychiatric = 0)
Long-term	1.53 (1.30–1.79)	<.001	1.29 (1.10–1.51)	.002	0.51 (0.44–0.59)	<.001

Data availability information

The data that support the findings of this study are available from the Ministry of Health, Labour and Welfare; however, restrictions apply to the availability of these data, which were used under license for the current study, and therefore, are not publicly available. The data are, however, available from the authors upon reasonable request and with the permission of the Ministry of Health, Labour and Welfare.