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在加拿大安大略省,移民身份与终身护理之间的关联
Christopher J Yarnell1, Longdi Fu2, Doug Manuel2,3
1University of Toronto Department of Medicine, Toronto, Ontario, Canada.
JAMA
|October 4, 2017
概括
与长期居住者相比,加拿大的新移民更有可能在生命末期接受重症监护,并在重症监护室死亡. 需要进一步的研究来了解生命终点护理中的这些差异.
科学领域:
- 医疗服务研究
- 移民健康
- 老年学
背景情况:
- 移民面临着独特的挑战,包括健康素养,沟通障碍和系统导航困难.
- 这些因素,以及不同的文化偏好,可以影响终身护理决策和经验.
研究的目的:
- 调查加拿大移民在生命最后六个月内接受的终身护理模式.
- 为了比较最近的移民和长期居民之间的终身护理的强度和位置.
主要方法:
- 2004年至2015年在加拿大安大略省进行的一项基于人口的队列研究,其中包括超过96.7万名死者.
- 卫生和移民数据库之间的验证联系确定了最近的移民 (自1985年以来移民) 和长期居民.
- 使用修改后的Poisson回归来分析移民身份与终身护理结果之间的关联,并对共变量进行调整.
主要成果:
- 与长期居住者相比,最近移民的死者在重症监护室死亡的可能性更高 (15.6%与10.0%相比),并接受了更多的重症监护入院 (24.9%与19.2%相比).
- 在使用机械通风,透析,输卵管放置和气管切除方面观察到显著差异.
- 在重症监护室死亡的可能性因出生地区而异,南亚地区的患者相对风险最高 (1.96).
结论:
- 在安大略省,最近的移民更有可能接受强烈的终身护理,并在重症监护室死亡.
- 了解这些差异的根本机制对于公平的终身护理提供至关重要.
- 需要进一步的研究来解决不同移民群体在生命结束时的具体需求和偏好.
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