End-of-life care for inpatients with schizophrenia: national claims database retrospective cohort study

This study aimed to clarify the end-of-life care among inpatients with schizophrenia, using a national claims database.

We conducted a retrospective cohort study of inpatients aged 20 years and older who died between 2012 and 2015, using a sampling dataset of the National Database (NDB) of Japan. The outcome was the proportion of patients who received end-of-life care in the last 14 days of life.

We analysed data from 49 932 end-of-life patients, 530 of whom had schizophrenia. Regarding the place of death, patients with schizophrenia died in psychiatric units (44.8% (95% CI 41.7 to 48.9)). A lower proportion of patients with schizophrenia received cardiopulmonary resuscitation (CPR) (16.6% vs 20.5%, p<0.001) or mechanical ventilation (13.4% vs 20.9%, p<0.001), but they were more likely to receive opioids (20.8% vs 19.0%, p=0.30) compared with those without schizophrenia. Multivariate logistic regression analysis showed that schizophrenia was negatively associated with receiving CPR (adj OR: 0.50 (95% CI 0.38 to 0.65), p<0.001) and mechanical ventilation (adj OR: 0.48 (95% CI 0.36 to 0.63), p<0.001), but positively associated with receiving opioids (adj OR: 1.57 (95% CI 1.18 to 2.09), p=0.002).

This study revealed the place of death and the provision of high-intensity end-of-life care for inpatients with schizophrenia, utilising the NDB of Japan.