Trajectory of healthcare use at end of life in osteoarthritis: a matched cohort study

Abstract

Purpose: Previous research suggests an increasing trend in the healthcare use towards death. However, little is known about the healthcare use in the last year of life among patients with osteoarthritis (OA). In this study, we aimed to fill this knowledge gap by comparing healthcare use at last year of life in persons with and without OA. Methods: The study is based on register data for the entire population of Skåne, the southernmost region in Sweden with a population of about 1.3 million in 2014 (13.2% of the Sweden’s population). The subjects were eligible for the study if they: 1) resided in Skåne in the 5 years prior to death, 2) were aged ≥65 years at death, 3) died between January 1, 2003 and December 31, 2014. Among eligible subjects, we identified those with a principal OA diagnosis (knee, hip, hand or other location) prior to the last year of life using data from the Skåne Healthcare Register (SHR) between 1998 and 2014 (n=18,520). For each OA subject, we randomly selected up to 4 comparators free of diagnosed OA (n=59,945) matched by sex, age at death, and year of death (527 persons with OA did not have any matched comparator and were excluded). We measured monthly physical healthcare consultations and inpatient days for each individual during the last 12 months of life. We applied two-part regression models to estimate the total and incremental healthcare use attributable to OA adjusted for sociodemographic variables and comorbidity. Results: During the last year of life, the estimated number of healthcare consultations per-person in the OA cohort was 18.7 (95% CI 18.4, 19.0) versus 16.2 (95% CI 16.0, 16.3) in subjects without OA, corresponding to an incremental healthcare consultation of 2.5 (95% CI 2.2, 2.8) per-person attributable to OA (1.2 [95% CI 1.1, 1.4] primary care consultations, 1.1 [0.9, 1.3] secondary outpatient care consultations, and 0.2 [0.1, 0.2] hospital admissions per-person). Moreover, persons with OA spent, on average, 1.8 (95% CI 1.3, 2.1) more days in hospital than their non-OA comparators during the last year of life. In both cohorts the healthcare consultations and inpatient days increased towards death (Figure 1). While excess healthcare consultations attributable to OA declined with time to death, the opposite was seen for inpatient days (Figure 2). Conclusions: OA was associated with greater healthcare use during the individuals’ last year of life. The contribution of hospital-based care increased toward deaths and this was more pronounced among persons with OA than those without, highlighting the need for improvement in outpatient care for OA patients.Figure 2Mean monthly excess healthcare consultations and inpatient days per-person attributable to osteoarthritis.View Large Image Figure ViewerDownload Hi-res image Download (PPT)