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      How many people will need palliative care in 2040? Past trends, future projections and implications for services

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          Abstract

          Background

          Current estimates suggest that approximately 75% of people approaching the end-of-life may benefit from palliative care. The growing numbers of older people and increasing prevalence of chronic illness in many countries mean that more people may benefit from palliative care in the future, but this has not been quantified. The present study aims to estimate future population palliative care need in two high-income countries.

          Methods

          We used mortality statistics for England and Wales from 2006 to 2014. Building on previous diagnosis-based approaches, we calculated age- and sex-specific proportions of deaths from defined chronic progressive illnesses to estimate the prevalence of palliative care need in the population. We calculated annual change over the 9-year period. Using explicit assumptions about change in disease prevalence over time, and official mortality forecasts, we modelled palliative care need up to 2040. We also undertook separate projections for dementia, cancer and organ failure.

          Results

          By 2040, annual deaths in England and Wales are projected to rise by 25.4% (from 501,424 in 2014 to 628,659). If age- and sex-specific proportions with palliative care needs remain the same as in 2014, the number of people requiring palliative care will grow by 25.0% (from 375,398 to 469,305 people/year). However, if the upward trend observed from 2006 to 2014 continues, the increase will be of 42.4% (161,842 more people/year, total 537,240). In addition, disease-specific projections show that dementia (increase from 59,199 to 219,409 deaths/year by 2040) and cancer (increase from 143,638 to 208,636 deaths by 2040) will be the main drivers of increased need.

          Conclusions

          If recent mortality trends continue, 160,000 more people in England and Wales will need palliative care by 2040. Healthcare systems must now start to adapt to the age-related growth in deaths from chronic illness, by focusing on integration and boosting of palliative care across health and social care disciplines. Countries with similar demographic and disease changes will likely experience comparable rises in need.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12916-017-0860-2) contains supplementary material, which is available to authorized users.

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          Most cited references31

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          Accuracy of death certificates for coding coronary heart disease as the cause of death.

          Death certificates are widely used in epidemiologic and clinical investigations and for national statistics. To examine the accuracy of death certificates for coding coronary heart disease as the underlying cause of death. Community-based inception cohort followed since 1948. Framingham, Massachusetts. 2683 deceased Framingham Heart Study participants. Sensitivity, specificity, and predictive values of the death certificate. The reference standard was cause of death adjudicated by a panel of three physicians. Among 2683 decedents, the death certificate coded coronary heart disease as the underlying cause of death for 942; the physician panel assigned coronary heart disease for 758. The death certificate had a sensitivity of 83.8% (95% CI, 81.1 % to 86.4%), positive predictive value of 67.4% (CI, 64.4% to 70.4%), specificity of 84.1% (CI, 82.4% to 85.7%), and negative predictive value of 92.9% (CI, 91.7% to 94.1%) for coronary heart disease. The death certificate assigned coronary heart disease in 51.2% of 242 deaths (9.0% of total deaths) for which the physician panel could not determine a cause. Compared with the physician panel, the death certificate attributed 24.3% more deaths to coronary heart disease overall and more than twice as many deaths to coronary heart disease in decedents who were at least 85 years of age. When deaths that were assigned unknown cause by the physician panel were excluded, the death certificate still assigned more deaths to coronary heart disease (7.9% overall and 43.1% in the oldest age group). Coronary heart disease may be overrepresented as a cause of death on death certificates. National mortality statistics, which are based on death certificate data, may overestimate the frequency of coronary heart disease by 7.9% to 24.3% overall and by as much as two-fold in older persons.
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            Risk of developing multimorbidity across all ages in an historical cohort study: differences by sex and ethnicity

            Objective To study the incidence of de novo multimorbidity across all ages in a geographically defined population with an emphasis on sex and ethnic differences. Design Historical cohort study. Setting All persons residing in Olmsted County, Minnesota, USA on 1 January 2000 who had granted permission for their records to be used for research (n=123 716). Participants We used the Rochester Epidemiology Project medical records-linkage system to identify all of the county residents. We identified and removed from the cohort all persons who had developed multimorbidity before 1 January 2000 (baseline date), and we followed the cohort over 14 years (1 January 2000 through 31 December 2013). Main outcome measures Incident multimorbidity was defined as the development of the second of 2 conditions (dyads) from among the 20 chronic conditions selected by the US Department of Health and Human Services. We also studied the incidence of the third of 3 conditions (triads) from among the 20 chronic conditions. Results The incidence of multimorbidity increased steeply with older age; however, the number of people with incident multimorbidity was substantially greater in people younger than 65 years compared to people age 65 years or older (28 378 vs 6214). The overall risk was similar in men and women; however, the combinations of conditions (dyads and triads) differed extensively by age and by sex. Compared to Whites, the incidence of multimorbidity was higher in Blacks and lower in Asians. Conclusions The risk of developing de novo multimorbidity increases steeply with older age, varies by ethnicity and is similar in men and women overall. However, as expected, the combinations of conditions vary extensively by age and sex. These data represent an important first step toward identifying the causes and the consequences of multimorbidity.
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              Accuracy of cancer death certificates and its effect on cancer mortality statistics.

              A study to determine the accuracy of cancer mortality data was done using cancer deaths occurring during 1970 and 1971 in eight of the nine areas included in the Third National Cancer Survey (TNCS). Death certificates with an underlying cause of death of cancer were compared to the hospital diagnosis for 48,826 resident cases of single primary cancers. The underlying cause of death as coded on the death certificate was found to be accurate for about 65 per cent of the cancer deaths in this study. Misclassification problems occurred for colorectal cancer, the second leading cause of death from cancer. Colon cancer was overreported and rectal cancer was under-reported on death certificates. Other misclassification problems were found for cancers of the uterus, brain, and buccal cavity including most of its sub-sites. Physicians tended to report a non-specific site of cancer on the death certificate rather than the specific site identified by the hospital diagnosis.
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                Author and article information

                Contributors
                simon.etkind@kcl.ac.uk
                anna.bone@kcl.ac.uk
                barbara.gomes@kcl.ac.uk
                natasha.lovell@kcl.ac.uk
                catherine.evans@kcl.ac.uk
                irene.higginson@kcl.ac.uk
                fliss.murtagh@kcl.ac.uk
                Journal
                BMC Med
                BMC Med
                BMC Medicine
                BioMed Central (London )
                1741-7015
                18 May 2017
                18 May 2017
                2017
                : 15
                : 102
                Affiliations
                [1 ]ISNI 0000 0001 2322 6764, GRID grid.13097.3c, , King’s College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, ; London, UK
                [2 ]ISNI 0000 0000 9511 4342, GRID grid.8051.c, , University of Coimbra, Faculty of Medicine, ; Coimbra, Portugal
                [3 ]Sussex Community NHS Foundation Trust, Brighton, UK
                Article
                860
                10.1186/s12916-017-0860-2
                5436458
                28514961
                9253722b-003f-41eb-9278-0c5e942432b3
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 18 November 2016
                : 21 April 2017
                Funding
                Funded by: Cicely Saunders International
                Award ID: 24610
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2017

                Medicine
                mortality,forecasting,palliative care,needs assessment,health services needs and demand,chronic disease,comorbidity

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