Health care utilization at the end of life in Parkinson´s disease: A population-based register study

Abstract

Background: Knowledge of healthcare utilization at the end of life in Parkinson’s disease (PD) is sparse. This study aims to investigate end of life health care utilization, characterized by emergency room (ER) visits, receipt of specialized palliative care (SPC), and place of death in a population-based PD cohort. Methods: We conducted a retrospective cohort study on deceased patients (≥18 years) with a PD diagnosis during their last year of life (n=922), based on healthcare-provider data from Region Stockholm´s data warehouse, for the study period 2015-2021. Univariable and multivariable logistic regression analyses tested associations and adjusted Odds ratios (aORs) were calculated. Results: During the last month of life, approx. half of the cohort had emergency room (ER) visits and risk of frailty (measured by Hospital Frailty Risk Score) significantly predicted these visits (aOR, 3.90 (2.75-5.55)). In total, 120 people (13%) received SPC during their last three months of life, which positively associated with risk for frailty, (aOR); 2.65 (1.43-4.94, p=0.002). In total, 284 people (31%) died in acute hospital settings. Among community-dwellers, male gender and frailty were strongly associated with acute hospital deaths (aOR, 1.90 (1.15-3.13, p=0.01) and 3.70 (1.96-6.98, p<0.0001)). Conclusions: Rates of ER visits at end of life and hospital deaths were relatively high in this population-based cohort. Considering a high disease burden, referral to SPC at end of life was relatively low. Sex-specific disparities in healthcare utilization are apparent. Identifying people with high risk for frailty could assist the planning of optimal end-of-life care for people with PD.