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Wolff SL, Christiansen CF, Johnsen SP, Schroeder H, Darlington AS, Jespersen BA, Olsen M, Neergaard MA. Inequality in place-of-death among children: a Danish nationwide study. Eur J Pediatr 2022; 181:609-617. [PMID: 34480639 DOI: 10.1007/s00431-021-04250-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/08/2021] [Accepted: 08/30/2021] [Indexed: 11/30/2022]
Abstract
To identify predictors for home death among children using socio-demographic factors and cause of death. It is a nationwide registry study. A cohort of children (1-17 years) who died between 1 January 2006 and 31 December 2016. It was set in Denmark, Europe. Predictors for home death were assessed: age, gender, diagnosis, region of residence, urbanicity, household income and immigrant status. Of 938 deceased children included, causes of death were solid tumours (17.3%), haematological cancers (8.5%) and non-cancerous conditions (74.2%). A total of 25% died at home. Compared to the lowest quartile, the groups with higher household income did not have a higher probability of dying at home (adjusted odds ratio (adj-OR) 0.8 (95% CI 0.5-1.2/1.3)). Dying of haematological cancers (adj-OR 0.3 (95% CI 0.2-0.7)) and non-cancerous conditions (adj-OR 0.5 (95% CI 0.3-0.7)) was associated with lower odds for home death compared to dying of solid tumours. However, being an immigrant was negatively associated with home death (adj-OR 0.6 (95% CI 0.4-0.9)). Moreover, a tendency was also found that being older, male, living outside the capital and in more urban areas were notable in relation to home death, however, not statistically significant.Conclusions: The fact that household income was not associated with dying at home may be explained by the Danish tax-financed healthcare system. However, having haematological cancers, non-cancerous conditions or being an immigrant were associated with lower odds for home death. Cultural differences along with heterogeneous trajectories may partly explain these differences, which should be considered prospectively. What is Known: • Prior studies have shown disparities in place-of-death of terminally ill children with diagnosis, ethnicity and socio-economic position as key factors. • Danish healthcare is tax-financed and in principle access to healthcare is equal; however, disparities have been found in the intensity of treatment of terminally ill children. What is New: • In a tax-financed, equal-access healthcare system, children died just as frequently at home in families with low as high household income. • Disparities in home death were related to diagnosis and immigrant status.
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Affiliation(s)
- Sanne Lausen Wolff
- Palliative Care Unit, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Søren Paaske Johnsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Henrik Schroeder
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Bodil Abild Jespersen
- Palliative Care Unit, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Marianne Olsen
- Copenhagen Palliative Care Team for Children and Adolescents, Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
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Wolff SL, Lorentzen I, Kaltoft AP, Schmidt H, Jeppesen MM, Maimburg RD. Has perinatal outcome improved after introduction of a guideline in favour of routine induction and increased surveillance prior to 42 weeks of gestation?: A cross-sectional population-based registry study. Sex Reprod Healthc 2016; 10:19-24. [PMID: 27938867 DOI: 10.1016/j.srhc.2016.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 01/20/2016] [Accepted: 03/08/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate whether new national guidelines of routine induction of labour and increased surveillance in low risk pregnancies at 41+2-5 weeks of gestation as an alternative to expectant management until 42+0 weeks of gestation has improved perinatal outcome. METHODS A questionnaire-based study regarding local induction practices among all Danish delivery units and a cross-sectional population-based registry study based on data from the Danish Medical Birth Registry (DMBR) in the years 2009-2012. OUTCOME MEASURES Primary outcomes were frequencies of induced labour and perinatal mortality; secondary outcomes were indicators of perinatal morbidity and instrumental delivery rates. RESULTS The questionnaire data showed that 22 of the 24 Danish delivery units complied with the new guidelines in 2012. The study population retrieved from the DMBR included 36,845 low-risk pregnancies at or beyond 41+2 weeks of gestation. The number of labour inductions within the study population had doubled after implementation of the new guideline. The increased proportion of induced labour did not appear to influence perinatal morbidity or instrumental delivery rates. Perinatal mortality remained steady in the years 2009, 2010 and 2011 whereas a reduction of 60 % was seen in 2012. However, this change was not statistically significant (P = 0.10). CONCLUSION This population-based study with a high reported adherence to the new national guideline found no changes in instrumental deliveries or perinatal outcomes after implementation of earlier routine induction of labour and increased surveillance in low risk pregnancies.
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Affiliation(s)
- Sanne Lausen Wolff
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Brendstrupgårdsvej 100, 8200 Aarhus N, Denmark.
| | - Iben Lorentzen
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Brendstrupgårdsvej 100, 8200 Aarhus N, Denmark
| | - Agnete Pers Kaltoft
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Brendstrupgårdsvej 100, 8200 Aarhus N, Denmark
| | - Heidi Schmidt
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Brendstrupgårdsvej 100, 8200 Aarhus N, Denmark
| | - Monique Mensink Jeppesen
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Brendstrupgårdsvej 100, 8200 Aarhus N, Denmark
| | - Rikke Damkjær Maimburg
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Brendstrupgårdsvej 100, 8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University Hospital, Brendstrupgårsdvej 100, 8200 Aarhus N, Denmark; Centre of Research in Rehabilitation (CORIR), Aarhus University Hospital, Brendstrupgårsdvej 100, 8200 Aarhus N, Denmark
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