Disparities in specialist palliative care for Taiwanese children and young adults impacted by local digital development and noncancer diagnoses.

Abstract

Disparities in specialist palliative care (SPC) are complex. Families of children and young adults with life-limiting conditions in digitally advanced areas have better access to health information and services. To examine SPC and end-of-life care for these patients, focusing on SPC referral rates and associated disparities. A retrospective study used national health insurance data in Taiwan. Patients aged 1-25 years who died with life-limiting conditions between 2009 and 2017 were included in this study (n = 6863). The main focus was on referrals to SPC, identified through service codes for palliative shared care, home care, and inpatient hospice. A total of 979 patients (14.3%) received SPC at least 3 days before death. Cancer patients were over 10 times more likely to receive SPC than noncancer patients, with an odds ratio of 10.77 (95% confidence interval [CI]: 9.08-12.77). Conversely, patients with congenital, hematological, neurological, or respiratory conditions were over 60% less likely to receive SPC than those without such conditions. Patients in well-digitally developed townships had higher SPC referrals rates (adjusted odds ratio [aOR]: 1.28; 95% CI: 1.11-1.48). SPC was associated with longer hospital stays in the last month of life (aOR: 2.64; 95% CI: 2.28-3.06) and increased hospital deaths (aOR: 8.36; 95% CI: 5.66-12.35), but less likely to be admitted to hospitals in the last 5 days of life (aOR: 0.61; 95% CI: 0.50-0.74). Few patients in Taiwan received SPC, highlighting that diagnosis is a significant predictor. This suggests a need for further investigation into resources for SPC.