Medical Care for the Elderly at the End of Life; National Big Data Analysis

• Project/Area Number: 18K17346
• Research Category: Grant-in-Aid for Early-Career Scientists
• Allocation Type: Multi-year Fund
• Review Section: Basic Section 58010:Medical management and medical sociology-related
• Research Institution: Ritsumeikan University (2020-2022); Kyoto University (2018-2019)
• Principal Investigator: SAKAI MICHI 立命館大学, 総合科学技術研究機構, 准教授 (10604697)
• Project Period (FY): 2018-04-01 – 2023-03-31
• Project Status: Completed (Fiscal Year 2022)
• Budget Amount: ¥3,770,000 (Direct Cost: ¥2,900,000、Indirect Cost: ¥870,000); Fiscal Year 2020: ¥1,040,000 (Direct Cost: ¥800,000、Indirect Cost: ¥240,000); Fiscal Year 2019: ¥1,040,000 (Direct Cost: ¥800,000、Indirect Cost: ¥240,000); Fiscal Year 2018: ¥1,690,000 (Direct Cost: ¥1,300,000、Indirect Cost: ¥390,000)
• Keywords: 終末期医療 / 高齢者医療 / レセプト / ビックデータ / NDB / 超高齢者 / レセプト情報・特定健診等情報データベー / レセプト情報・特定健診等情報データベース / 終末期高齢者 / 保健医療ビッグデータ / 終末期 / 高齢者 / National Data Base（NDB）

Outline of Final Research Achievements

1) Validation of Claims Data to Identify Death among Aged Persons: The sensitivity of identifying death from the receipts was 94.3% for inpatient and 47.4% for outpatient, indicating that inpatient death information is highly valid, but the use of death information obtained from outpatient receipts is not recommended.
2) A Time-Trend Analysis from 2012 through 2014 Based on a Nationally Representative SampleUsing NDB: We examined changes over time in medical care for the terminally ill elderly: from H24 to H26, cardiopulmonary resuscitation, ventilation, and ICU admissions in the 7 days before death decreased from 11.0% to 8.3%, 13.1% to 9.8%, and 9.1% to 7.8%, respectively.
3) Regional differences in end-of-life care were examined in a multilevel model using NDB. The subjects were hospitalized patients aged 75 years or older, regional differences in cardiopulmonary resuscitation, ventilation, and ICU admission prior to death were analyzed. (before publication)

Academic Significance and Societal Importance of the Research Achievements

日本医師会は「終末期医療に関する答申」で、形式的な延命は患者の尊厳を侵し、患者の意思、利益に反している場合があるとの認識に立ちながら、何をもって過剰医療かの判断は難しいことから、関係者間の合意形成プロセスの重要性を強調してきた（第XV次生命倫理懇談会答申.2017）。
本研究は「日本の国の高齢者が、先進国に相応しく、等しく、尊厳のある生と死を全うできているのか」という問いに関する議論を深化させ、合意形成の基礎となる情報と共に、診療のばらつきとその要因の解明により、終末期医療のあるべき姿の検討に資する情報となると考える。

Research Products

• [Journal Article] 高齢患者の死亡前の生命維持治療 の状況：全国データによる分析 (2022)
  • Author(s): 酒井未知、中山健夫
  • Journal Title: Geriatric Medicine （老年医学) Volume: 60 Pages: 313-317
• [Journal Article] Decreased Administration of Life-Sustaining Treatment just before Death among Older Inpatients in Japan: A Time-Trend Analysis from 2012 through 2014 Based on a Nationally Representative Sample. (2021)
  • Author(s): (1)Sakai, M.; Ohtera, S.; Iwao,T.; Neff, Y.; Uchida, T.; Takahashi, Y.;Kato, G.; Kuroda, T.; Nishimura, S.;Nakayama, T.; ;BiDAME (Big Data Analysis of Medical care for the Elderly in Kyoto)
  • Journal Title: Int. J. Environ. Res. Public Health Volume: 18 Issue: 6 Pages: 3135-3135
  • DOI: 10.3390/ijerph18063135
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Validation of claims data to identify death among aged persons utilizing enrollment data from health insurance unions (2019)
  • Author(s): Sakai M.、on behalf of BiDAME (Big Data Analysis of Medical care for the Elderly in Kyoto)、Ohtera S.、Iwao T.、Neff Y.、Kato G.、Takahashi Y.、Nakayama T.
  • Journal Title: Environmental Health and Preventive Medicine Volume: 24 Issue: 1 Pages: 63-63
  • DOI: 10.1186/s12199-019-0819-3
  • Peer Reviewed / Open Access