Introduction
Aim
Subjects and methods
Data source
Study design
Study population
Identification of palliative care conditions
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Documentation of general outpatient palliative care treatment (AAPV) based on the following codes for the reimbursement of outpatient procedures (EBM-codes): 04370, 04371, 04372, 04373, 03370, 03371, 03372, 03373.
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Documentation of specific outpatient palliative care treatment (SAPV) based on the following codes for the reimbursement of outpatient procedures (EBM-codes): 01425, 01426.
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Documentation of inpatient palliative care treatment based on the following codes for the reimbursement of inpatient procedures (OPS-codes): 8–982, 8-98e. The OPS-code 8-98 h was not considered, since it was introduced in 2017.
Identification of deaths
Patient comorbidity
Statistical analyses
Results
Patient characteristics
Women (n = 8031) | Men (n = 6491) | All (n = 14,522) | ||||
---|---|---|---|---|---|---|
N | % | N | % | N | % | |
Age | ||||||
0–9 years | 16 | 0.2% | 13 | 0.2% | 29 | 0.2% |
10–19 years | 19 | 0.2% | 15 | 0.2% | 34 | 0.2% |
20–29 years | 19 | 0.2% | 20 | 0.3% | 39 | 0.3% |
30–39 years | 45 | 0.6% | 46 | 0.7% | 91 | 0.6% |
40–49 years | 182 | 2.3% | 139 | 2.1% | 321 | 2.2% |
50–59 years | 534 | 6.6% | 510 | 7.9% | 1044 | 7.2% |
60–69 years | 882 | 11.0% | 1088 | 16.8% | 1970 | 13.6% |
70–79 years | 1812 | 22.6% | 2139 | 33.0% | 3951 | 27.2% |
80–89 years | 2803 | 34.9% | 1982 | 30.5% | 4785 | 33.0% |
> 90 years | 1719 | 21.4% | 539 | 8.3% | 2258 | 15.5% |
All | 8031 | 100.0% | 6491 | 100.0% | 14,522 | 100.0% |
Mean age (mean, SD) | 78.7 | 13.8 | 74.7 | 12.7 | 76.9 | 13.4 |
Sex | ||||||
Female | 8031 | 100.0% | – | – | 8031 | 55.3% |
Male | – | – | 6491 | 100.0% | 6491 | 44.7% |
Initial palliative care treatment | ||||||
General outpatient palliative care (AAPV) | 6265 | 78.0% | 4782 | 73.7% | 11,047 | 76.1% |
Specialized outpatient palliative care (SAPV) | 690 | 8.6% | 658 | 10.1% | 1348 | 9.3% |
Inpatient complex palliative treatment | 1076 | 13.4% | 1051 | 16.2% | 2127 | 14.6% |
Women (n = 8031) | Men (n = 6491) | All (n = 14,522) | ||||
---|---|---|---|---|---|---|
N | % | N | % | N | % | |
Elixhauser comorbidity score | ||||||
0 diseases | 111 | 1.4% | 82 | 1.3% | 193 | 1.3% |
1 disease | 266 | 3.3% | 180 | 2.8% | 446 | 3.1% |
2 diseases | 525 | 6.5% | 333 | 5.1% | 858 | 5.9% |
3 diseases | 757 | 9.4% | 503 | 7.7% | 1260 | 8.7% |
4 diseases | 902 | 11.2% | 671 | 10.3% | 1573 | 10.8% |
5 diseases | 989 | 12.3% | 753 | 11.6% | 1742 | 12.0% |
> 6 diseases | 4481 | 55.8% | 3969 | 61.1% | 8450 | 58.2% |
Mean number of diseases (mean, SD) | 6.4 | 3.2 | 6.8 | 3.2 | 6.6 | 3.2 |
Specific oncological comorbidity (localization) | ||||||
Any malignant neoplasm | 3974 | 49.5% | 4216 | 65.0% | 8190 | 56.4% |
Lip, oral cavity and pharynx | 97 | 1.2% | 213 | 3.3% | 310 | 2.1% |
Digestive organs | 1102 | 13.7% | 1331 | 20.5% | 2433 | 16.8% |
Respiratory and intrathoracic organs | 598 | 7.4% | 929 | 14.3% | 1527 | 10.5% |
Bone and articular cartilage | 45 | 0.6% | 36 | 0.6% | 81 | 0.6% |
Melanoma and other malignant neoplasms of skin | 478 | 6.0% | 579 | 8.9% | 1057 | 7.3% |
Mesothelial and soft tissue | 161 | 2.0% | 159 | 2.4% | 320 | 2.2% |
Breast | 1166 | 14.5% | 13 | 0.2% | 1179 | 8.1% |
Female genital organs | 543 | 6.8% | < 5 | – | – | – |
Male genital organs | < 5 | – | 986 | 15.2% | – | – |
Urinary tract | 254 | 3.2% | 600 | 9.2% | 854 | 5.9% |
Eye, brain and other parts of central nervous system | 123 | 1.5% | 143 | 2.2% | 266 | 1.8% |
Thyroid and other endocrine glands | 73 | 0.9% | 61 | 0.9% | 134 | 0.9% |
Hodgkin lymphoma | 19 | 0.2% | 23 | 0.4% | 42 | 0.3% |
Non-Hodgkin lymphoma | 145 | 1.8% | 192 | 3.0% | 337 | 2.3% |
Leukaemia | 110 | 1.4% | 178 | 2.7% | 288 | 2.0% |
Secondary neoplasms | 2037 | 25.4% | 2228 | 34.3% | 4265 | 29.4% |
Other types of cancer | 628 | 7.8% | 714 | 11.0% | 1342 | 9.2% |
Specific non-oncological comorbidity | ||||||
Heart failure | 2950 | 36.7% | 2148 | 33.1% | 5098 | 35.1% |
Kidney failure | 2531 | 31.5% | 2166 | 33.4% | 4697 | 32.3% |
Respiratory failure | 1005 | 12.5% | 1083 | 16.7% | 2088 | 14.4% |
Liver disease | 1258 | 15.7% | 1408 | 21.7% | 2666 | 18.4% |
Chronic obstructive pulmonary disease | 1318 | 16.4% | 1516 | 23.4% | 2834 | 19.5% |
Depression | 3095 | 38.5% | 1544 | 23.8% | 4639 | 31.9% |
Incidence of cases with reimbursement codes for palliative care conditions
Women (n = 8031) | Men (n = 6491) | All (n = 14,522) | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Age | N population | n cases | Incidence per 10,000 persons | 95% CI | N population | n cases | Incidence per 10,000 persons | 95% CI | N population | n cases | Incidence per 10,000 persons | 95% CI |
0–9 years | 124,535 | 16 | 1.3 | 0.7–1.9 | 131,220 | 13 | 1.0 | 0.5–1.5 | 255,755 | 29 | 1.1 | 0.7–1.5 |
10–19 years | 179,177 | 19 | 1.1 | 0.6–1.5 | 189,376 | 15 | 0.8 | 0.4–1.2 | 368,553 | 34 | 0.9 | 0.6–1.2 |
20–29 years | 202,284 | 19 | 0.9 | 0.5–1.4 | 207,964 | 20 | 1.0 | 0.5–1.4 | 410,248 | 39 | 1.0 | 0.7–1.2 |
30–39 years | 229,943 | 45 | 2.0 | 1.4–2.5 | 233,035 | 46 | 2.0 | 1.4–2.5 | 462,978 | 91 | 2.0 | 1.6–2.4 |
40–49 years | 271,988 | 182 | 6.7 | 5.7–7.7 | 278,389 | 139 | 5.0 | 4.2–5.8 | 550,377 | 321 | 5.8 | 5.2–6.5 |
50–59 years | 311,805 | 534 | 17.1 | 15.7–18.6 | 316,200 | 510 | 16.1 | 14.7–17.5 | 628,005 | 1044 | 16.6 | 15.6–17.6 |
60–69 years | 238,399 | 882 | 37.0 | 34.6–39.4 | 226,143 | 1088 | 48.1 | 45.3–51.0 | 464,542 | 1970 | 42.4 | 40.5–44.3 |
70–79 years | 224,534 | 1812 | 80.7 | 77.0–84.4 | 187,828 | 2139 | 113.9 | 109.1–118.7 | 412,362 | 3951 | 95.8 | 92.8–98.8 |
80–89 years | 131,125 | 2803 | 213.8 | 205.9–221.6 | 82,074 | 1982 | 241.5 | 231.0–252.0 | 213,199 | 4785 | 224.4 | 218.2–230.7 |
≥ 90 years | 31,749 | 1719 | 541.4 | 516.5–566.3 | 9609 | 539 | 560.9 | 514.9–606.9 | 41,358 | 2258 | 546.0 | 524.1–567.9 |
All | 1,945,539 | 8031 | 41.3 | 40.4–42.2 | 1,861,838 | 6491 | 34.9 | 34.0–35.7 | 3,807,377 | 14,522 | 38.1 | 37.5–38.8 |
Prevalence of cases with reimbursement codes for palliative care conditions
Age | Women (n = 11,948) | Men (n = 9540) | All (n = 21,488) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
N population | n cases | Prevalence per 10,000 persons | 95% CI | N population | n cases | Prevalence per 10,000 persons | 95% CI | N population | n cases | Prevalence per 10,000 persons | 95% CI | |
0–9 years | 124,544 | 25 | 2.0 | 1.2–2.8 | 131,243 | 36 | 2.7 | 1.8–3.6 | 255,787 | 61 | 2.4 | 1.8–3.0 |
10–19 years | 179,186 | 27 | 1.5 | 0.9–2.1 | 189,391 | 30 | 1.6 | 1.0–2.2 | 368,577 | 57 | 1.5 | 1.1–1.9 |
20–29 years | 202,296 | 31 | 1.5 | 1.0–2.1 | 207,986 | 41 | 2.0 | 1.4–2.6 | 410,282 | 72 | 1.8 | 1.3–2.2 |
30–39 years | 229,971 | 69 | 3.0 | 2.3–3.7 | 233,060 | 69 | 3.0 | 2.3–3.7 | 463,031 | 138 | 3.0 | 2.5–3.5 |
40–49 years | 272,102 | 277 | 10.2 | 9.0–11.4 | 278,461 | 200 | 7.2 | 6.2–8.2 | 550,563 | 477 | 8.7 | 7.9–9.4 |
50–59 years | 312,156 | 838 | 26.8 | 25.0–28.7 | 316,509 | 783 | 24.7 | 23.0–26.5 | 628,665 | 1621 | 25.8 | 24.5–27.0 |
60–69 years | 238,985 | 1371 | 57.4 | 54.3–60.4 | 226,785 | 1642 | 72.4 | 68.9–75.9 | 465,770 | 3013 | 64.7 | 62.4–67.0 |
70–79 years | 225,638 | 2775 | 123.0 | 118.4–127.5 | 188,993 | 3156 | 167.0 | 161.2–172.8 | 414,631 | 5931 | 143.0 | 139.4–146.7 |
80–89 years | 132,455 | 4052 | 305.9 | 296.6–315.2 | 82,986 | 2836 | 341.7 | 329.4–354.1 | 215,441 | 6888 | 319.7 | 312.3–327.1 |
≥ 90 years | 32,528 | 2483 | 763.3 | 734.5–792.2 | 9825 | 747 | 760.3 | 707.9–812.7 | 42,353 | 3230 | 762.6 | 737.4–787.9 |
All | 1,949,861 | 11,948 | 61.3 | 60.2–62.4 | 1,865,239 | 9540 | 51.1 | 50.1–52.2 | 3,815,100 | 21,488 | 56.3 | 55.6–57.1 |