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Article(id=1321169668627345472, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1321169578152014376, articleNumber=null, orderNo=null, doi=10.11847/zgggws1147314, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1742832000000, receivedDateStr=2025-03-25, revisedDate=1753545600000, revisedDateStr=2025-07-27, acceptedDate=1758816000000, acceptedDateStr=2025-09-26, onlineDate=1792920995145, onlineDateStr=2026-10-25, pubDate=1760025600000, pubDateStr=2025-10-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1792920995145, onlineIssueDateStr=2026-10-25, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1792920995145, creator=13701087609, updateTime=1792920995145, updator=13701087609, issue=Issue{id=1321169578152014376, tenantId=1146029695717560320, journalId=1319373219989389464, year='2025', volume='41', issue='10', pageStart='1153', pageEnd='1280', issueExtLink='null', onlineDate='null', pubDate='1760025600000', pubDateStr='2025-10-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1792920973575, creator='13701087609', updateTime=1792920973575, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=1220, endPage=1225, ext={EN=ArticleExt(id=1321169668845449281, articleId=1321169668627345472, tenantId=1146029695717560320, journalId=1319373219989389464, language=EN, title=Places of death and changing trends of residents in Hunan province from 2014 to 2023: an analysis based on cause-of-death surveillance data, columnId=1320427686514770171, journalTitle=Chinese Journal of Public Health, columnName=Survey and Report, runingTitle=null, highlight=null, articleAbstract=
Objective

To understand the changing trends of places of death among residents in Hunan province from 2014 to 2023 and provide an empirical basis for constructing a hospice care service system in line with national conditions.

Methods

The cause-of-death surveillance data of Hunan province from 2014 to 2023 were collected. The 2020 Hunan census data were taken as the standard population to calculate the age-standardized composition ratio of the places of death. The Joinpoint regression model was adopted to analyze the changing trend of different places of death.

Results

From 2014 to 2023, 81.18% of the registered deaths in Hunan province were dying at home, with an average annual increase of 0.40% (AAPC = 0.40%, P < 0.001). The ratio of death in hospitals first decreased (2014–2017: APC =–2.49%, P = 0.020) and then increased (2017–2023: APC = 1.55%, P < 0.001). The ratio of death in nursing institutions increased by 8.59% annually (AAPC = 8.59%, P < 0.001). The ratio of death on the way to hospitals decreased by 4.32% annually (AAPC = –4.32%, P < 0.001). From 2014 to 2023, the ratio of death in rural hospitals in Hunan province was 8.52%, which differed from that (19.69%) in urban hospitals (χ2 = 106 862.300, P < 0.001). The ratio of death in rural hospitals increased by 1.31% annually (AAPC = 1.31%, P < 0.001).

Conclusions

Home is still the dominated place of death in Hunan province, while the ratios of death in hospitals and nursing institutions are rising rapidly. Future policies should balance resource equity and cultural adaptation and improve medical access while maintaining the diversity and dignity of end-of-life choices.

, authors=Danyi MAO, Zichuan LI, Yixin XIE, Donghui JIN, authorsList=Danyi MAO, Zichuan LI, Yixin XIE, Donghui JIN, authorCompany=null, correspAuthors=Donghui JIN, authorNote=null, correspAuthorsNote=
JIN Donghui, E-mail:
, copyrightStatement=Copyright © 2025 Chinese Journal of Public Health. All rights reserved., copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1321169669495566402, articleId=1321169668627345472, tenantId=1146029695717560320, journalId=1319373219989389464, language=CN, title=2014—2023年湖南省居民临终地点及变化趋势：基于死因监测资料的分析, columnId=1320427686770622717, journalTitle=中国公共卫生, columnName=调查报告与分析, runingTitle=null, highlight=null, articleAbstract=
目的

分析2014—2023年湖南省居民临终地点变化趋势，为构建符合国情的临终关怀服务体系提供实证依据。

方法

收集2014—2023年湖南省死因监测数据，以2020年湖南省人口普查数据为标准人口，计算经年龄标准化的临终地点构成比，采用Joinpoint回归模型分析不同临终地点的变化趋势。

结果

2014—2023年，湖南省登记死亡人口中居家临终占比81.18%、年均上升0.40%（AAPC=0.40%，P<0.001）；医疗机构临终构成比呈现先降（2014—2017年APC= −2.49%，P=0.020）后升（2017—2023年APC=1.55%，P<0.001）；养老机构临终构成比年均增长8.59%（AAPC=8.59%，P<0.001）；来院途中临终构成比年均下降4.32%（AAPC= −4.32%，P<0.001）。2014—2023年，湖南省医疗机构临终构成比农村（8.52%）与城市（19.69%）比较差异有统计学意义（χ2=106 862.300，P<0.001），农村医疗机构临终构成比年均上升1.31%（AAPC=1.31%，P<0.001）。

结论

湖南省临终地点仍以居家为主，但医疗机构和养老机构占比快速上升，呈现机构化转型趋势。未来政策需平衡“资源公平”与“文化适配”，在提升医疗可及性的同时维护临终选择的多样性与尊严。

, authors=毛丹怡, 李子川, 谢旖欣, 金东辉*, *, authorsList=毛丹怡, 李子川, 谢旖欣, 金东辉, authorCompany=null, correspAuthors=金东辉, authorNote=

毛丹怡（1999—），硕士，研究方向：卫生统计

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金东辉，E-mail：
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Hospital-based palliative and end-of-life care in the COVID-19 pandemic: a scoping review[J]. American Journal of Hospice and Palliative Medicine, 2022, 39(9): 1105-1120., articleTitle=null, refAbstract=null), Reference(id=1321169678085501058, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169668627345472, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=19, rfOrder=18, authorNames=null, journalName=null, refType=null, unstructuredReference=陈芷谦, 郭巧红. 新冠疫情对安宁疗护工作的影响及应对策略[J]. 医学与哲学, 2020, 41(23): 29-31., articleTitle=null, refAbstract=null), Reference(id=1321169678207135875, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169668627345472, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=20, rfOrder=19, authorNames=null, journalName=null, refType=null, unstructuredReference=陈林利, 张雨欣, 王静雅, 等. 上海市闵行区2016—2020年1—4月份居民死亡监测结果分析[J]. 上海预防医学, 2021, 33(4): 335-339., articleTitle=null, refAbstract=null), Reference(id=1321169678316187780, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169668627345472, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=21, rfOrder=20, authorNames=null, journalName=null, refType=null, unstructuredReference=Gu D N, Liu G Y, Vlosky D A, et al. 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Main characteristics of different places of death in Hunan province from 2014 to 2023

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总死亡不同临终地点死亡
例数构成比/%家中医疗卫生机构养老服务机构来院途中其他
人数构成比/%人数构成比/%人数构成比/%人数构成比/%人数构成比/%
地区
　农村2 317 26357.401 993 50060.80197 48836.807 22938.0049 40760.2069 63956.70
　城市1 720 34642.601 284 04539.20338 68063.2011 77262.0032 63439.8053 21543.30
年龄/岁
　0～<1533 6070.8311 2910.3413 5352.52220.122 2172.706 5425.33
　15～<65860 81121.30605 39318.50160 19529.902 09211.0026 33832.1066 79354.40
　65～<852 149 64353.201 796 44954.80264 38749.3010 89957.4038 87447.4039 03431.80
　≥85993 54824.60864 41226.4098 05118.305 98831.5014 61217.8010 4858.53
性别
　男性2 370 90758.701 878 96957.30342 59663.9012 19464.2051 41462.7085 73469.80
　女性1 666 70241.301 398 57642.70193 57236.106 80735.8030 62737.3037 12030.20
民族
　汉族3 756 56093.003 036 16392.60514 53496.0018 25696.1075 19591.70112 41291.50
　其他281 0496.96241 3827.3621 6344.037453.926 8468.3410 4428.50
职业
　专技/职员/公务员46 9461.1618 8810.5823 3064.352581.361 7532.142 7482.24
　工人/自由职业/企业管理105 9992.6353 9711.6540 6607.585492.893 7234.547 0965.78
　农民3 217 03279.702 854 24187.10209 49439.1010 19953.7058 79871.7084 30068.60
　离退休人员334 3758.28154 1564.70162 55830.304 69824.707 5129.165 4514.44
　无业/学生151 1583.7493 5772.8641 2277.691 5818.324 2865.2210 4878.54
　其他182 0994.51102 7193.1358 92311.001 7169.035 9697.2812 77210.40
受教育程度
　初中及以下3 736 55492.503 137 33595.70406 43175.8017 14190.2072 04287.80103 60584.30
　高中239 1345.92122 4253.7491 65617.101 3307.008 0949.8715 62912.70
　大学及以上61 9211.5317 7850.5438 0817.105302.791 9052.323 6202.95
婚姻状况
　未婚136 9233.3976 2602.3333 3146.214 25422.405 1676.3017 92814.60
　已婚2 864 18670.902 302 40270.20406 57275.807 44639.2061 52875.0086 23870.20
　离婚31 6290.7819 3460.599 2011.725062.665720.702 0041.63
　丧偶951 21823.60841 05525.7079 34614.806 51134.3013 72316.7010 5838.61
　未说明53 6531.3338 4821.177 7351.442841.491 0511.286 1014.97
合计4 037 609100.003 277 54581.18536 16813.2819 0010.4782 0412.03122 8543.04
), ArticleFig(id=1321169673949917286, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169668627345472, language=CN, label=表1, caption=

2014—2023湖南省不同临终地点的主要特征分布

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总死亡不同临终地点死亡
例数构成比/%家中医疗卫生机构养老服务机构来院途中其他
人数构成比/%人数构成比/%人数构成比/%人数构成比/%人数构成比/%
地区
　农村2 317 26357.401 993 50060.80197 48836.807 22938.0049 40760.2069 63956.70
　城市1 720 34642.601 284 04539.20338 68063.2011 77262.0032 63439.8053 21543.30
年龄/岁
　0～<1533 6070.8311 2910.3413 5352.52220.122 2172.706 5425.33
　15～<65860 81121.30605 39318.50160 19529.902 09211.0026 33832.1066 79354.40
　65～<852 149 64353.201 796 44954.80264 38749.3010 89957.4038 87447.4039 03431.80
　≥85993 54824.60864 41226.4098 05118.305 98831.5014 61217.8010 4858.53
性别
　男性2 370 90758.701 878 96957.30342 59663.9012 19464.2051 41462.7085 73469.80
　女性1 666 70241.301 398 57642.70193 57236.106 80735.8030 62737.3037 12030.20
民族
　汉族3 756 56093.003 036 16392.60514 53496.0018 25696.1075 19591.70112 41291.50
　其他281 0496.96241 3827.3621 6344.037453.926 8468.3410 4428.50
职业
　专技/职员/公务员46 9461.1618 8810.5823 3064.352581.361 7532.142 7482.24
　工人/自由职业/企业管理105 9992.6353 9711.6540 6607.585492.893 7234.547 0965.78
　农民3 217 03279.702 854 24187.10209 49439.1010 19953.7058 79871.7084 30068.60
　离退休人员334 3758.28154 1564.70162 55830.304 69824.707 5129.165 4514.44
　无业/学生151 1583.7493 5772.8641 2277.691 5818.324 2865.2210 4878.54
　其他182 0994.51102 7193.1358 92311.001 7169.035 9697.2812 77210.40
受教育程度
　初中及以下3 736 55492.503 137 33595.70406 43175.8017 14190.2072 04287.80103 60584.30
　高中239 1345.92122 4253.7491 65617.101 3307.008 0949.8715 62912.70
　大学及以上61 9211.5317 7850.5438 0817.105302.791 9052.323 6202.95
婚姻状况
　未婚136 9233.3976 2602.3333 3146.214 25422.405 1676.3017 92814.60
　已婚2 864 18670.902 302 40270.20406 57275.807 44639.2061 52875.0086 23870.20
　离婚31 6290.7819 3460.599 2011.725062.665720.702 0041.63
　丧偶951 21823.60841 05525.7079 34614.806 51134.3013 72316.7010 5838.61
　未说明53 6531.3338 4821.177 7351.442841.491 0511.286 1014.97
合计4 037 609100.003 277 54581.18536 16813.2819 0010.4782 0412.03122 8543.04
), ArticleFig(id=1321169675619250280, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169668627345472, language=EN, label=Tab.2, caption=

Composition ratio of places of death in different years in Hunan province

, figureFileSmall=null, figureFileBig=null, tableContent=
年份登记死亡数/人不同临终地点死亡
家中医疗卫生机构养老服务机构来院途中其他
人数构成比/%人数构成比/%人数构成比/%人数构成比/%人数构成比/%
2014253 494203 39480.2433 81513.347880.316 2482.469 2493.65
2015312 025253 27681.1740 16212.871 0980.356 4752.0811 0143.53
2016370 726303 32481.8245 92312.391 2550.347 9252.1412 2993.32
2017400 008328 28982.0749 24612.311 4690.378 5992.1512 4053.10
2018409 969335 50681.8452 30412.761 6170.397 8751.9212 6673.09
2019437 313356 59381.5455 88512.782 0220.469 8622.2612 9512.96
2020427 584348 15781.4256 49313.212 0000.477 6981.8013 2363.10
2021442 747359 52081.2059 47813.432 2230.508 1511.8413 3753.02
2022488 126390 18079.9372 24014.803 1060.649 5361.9513 0642.68
2023495 617399 30680.5770 62214.2534230.699 6721.9512 5942.54
), ArticleFig(id=1321169675715719273, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169668627345472, language=CN, label=表2, caption=

不同年份湖南省登记死亡居民各临终地点构成

, figureFileSmall=null, figureFileBig=null, tableContent=
年份登记死亡数/人不同临终地点死亡
家中医疗卫生机构养老服务机构来院途中其他
人数构成比/%人数构成比/%人数构成比/%人数构成比/%人数构成比/%
2014253 494203 39480.2433 81513.347880.316 2482.469 2493.65
2015312 025253 27681.1740 16212.871 0980.356 4752.0811 0143.53
2016370 726303 32481.8245 92312.391 2550.347 9252.1412 2993.32
2017400 008328 28982.0749 24612.311 4690.378 5992.1512 4053.10
2018409 969335 50681.8452 30412.761 6170.397 8751.9212 6673.09
2019437 313356 59381.5455 88512.782 0220.469 8622.2612 9512.96
2020427 584348 15781.4256 49313.212 0000.477 6981.8013 2363.10
2021442 747359 52081.2059 47813.432 2230.508 1511.8413 3753.02
2022488 126390 18079.9372 24014.803 1060.649 5361.9513 0642.68
2023495 617399 30680.5770 62214.2534230.699 6721.9512 5942.54
), ArticleFig(id=1321169675816382570, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169668627345472, language=EN, label=Tab.3, caption=

AAPC and APC of composition ratio of places of death in Hunan province from 2014 to 2023

, figureFileSmall=null, figureFileBig=null, tableContent=
临终地点AAPC/%95%CIP值年份APC/%95%CIP值
医疗卫生机构0.19−0.35，0.800.4012014—2017−2.49 a−5.60，−0.290.020
2017—20231.55 a0.94，3.11<0.001
家中0.40 a0.28，0.55<0.0012014—20171.58 a1.01，2.35<0.001
2017—2023−0.19 a−0.38，−0.010.042
养老服务机构8.59 a6.54，10.97<0.0012014—20170.87−10.37，8.470.755
2017—202312.66 a10.69，19.32<0.001
来院途中−4.32 a−6.05，−2.83<0.0012014—2021−5.79−11.96，3.290.099
2021—20230.99−7.20，7.200.944
其他−1.32 a−2.51，−0.090.0372014—2023−1.32 a−2.51，−0.090.037
), ArticleFig(id=1321169675900268651, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169668627345472, language=CN, label=表3, caption=

2014—2023年湖南省不同临终地点构成比AAPC和APC结果

, figureFileSmall=null, figureFileBig=null, tableContent=
临终地点AAPC/%95%CIP值年份APC/%95%CIP值
医疗卫生机构0.19−0.35，0.800.4012014—2017−2.49 a−5.60，−0.290.020
2017—20231.55 a0.94，3.11<0.001
家中0.40 a0.28，0.55<0.0012014—20171.58 a1.01，2.35<0.001
2017—2023−0.19 a−0.38，−0.010.042
养老服务机构8.59 a6.54，10.97<0.0012014—20170.87−10.37，8.470.755
2017—202312.66 a10.69，19.32<0.001
来院途中−4.32 a−6.05，−2.83<0.0012014—2021−5.79−11.96，3.290.099
2021—20230.99−7.20，7.200.944
其他−1.32 a−2.51，−0.090.0372014—2023−1.32 a−2.51，−0.090.037
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Composition of medical institutions as places of death in rural and urban areas from 2014 to 2023

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年份农村城市χ2值P值
登记死亡数/人医疗机构死亡数/人医疗机构临终构成比/%登记死亡数/人医疗机构死亡数/人医疗机构临终构成比/%
2014141 86411 1067.83111 63022 70920.348 462.379<0.001
2015179 67312 6797.06132 35227 48320.7712 769.312<0.001
2016219 55915 7037.15151 16730 22019.9913 596.918<0.001
2017237 19517 8717.53162 81331 37519.2712 316.900<0.001
2018242 89419 4578.01167 07532 84719.6612 068.354<0.001
2019248 96420 2258.12188 34935 66018.9311 239.319<0.001
2020243 51921 5308.84184 06534 96318.999 424.539<0.001
2021250 66322 5759.01192 08436 90319.219 739.379<0.001
2022274 27327 74310.12213 85344 49720.8110 893.739<0.001
2023278 65928 59910.26216 95842 02319.378 277.465<0.001
合计2 317 263197 4888.521 720 346338 68019.69106 862.300<0.001
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2014—2023年农村和城市地区医疗卫生机构临终构成

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年份农村城市χ2值P值
登记死亡数/人医疗机构死亡数/人医疗机构临终构成比/%登记死亡数/人医疗机构死亡数/人医疗机构临终构成比/%
2014141 86411 1067.83111 63022 70920.348 462.379<0.001
2015179 67312 6797.06132 35227 48320.7712 769.312<0.001
2016219 55915 7037.15151 16730 22019.9913 596.918<0.001
2017237 19517 8717.53162 81331 37519.2712 316.900<0.001
2018242 89419 4578.01167 07532 84719.6612 068.354<0.001
2019248 96420 2258.12188 34935 66018.9311 239.319<0.001
2020243 51921 5308.84184 06534 96318.999 424.539<0.001
2021250 66322 5759.01192 08436 90319.219 739.379<0.001
2022274 27327 74310.12213 85344 49720.8110 893.739<0.001
2023278 65928 59910.26216 95842 02319.378 277.465<0.001
合计2 317 263197 4888.521 720 346338 68019.69106 862.300<0.001
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Trends in the composition ratio of medical institutions as places of death in rural and urban areas from 2014 to 2023

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地区AAPC/%95%CIP值年份APC/%95%CIP值
农村1.31 a0.91，2.20<0.0012014—2016−3.15−5.22，1.290.222
2016—20232.63 a1.99，4.600.003
城市−0.74−1.72，0.340.1802014—2023−0.74−1.72，0.340.180
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2014—2023年农村和城市地区医疗卫生机构临终构成比变化趋势

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地区AAPC/%95%CIP值年份APC/%95%CIP值
农村1.31 a0.91，2.20<0.0012014—2016−3.15−5.22，1.290.222
2016—20232.63 a1.99，4.600.003
城市−0.74−1.72，0.340.1802014—2023−0.74−1.72，0.340.180
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2014—2023年湖南省居民临终地点及变化趋势：基于死因监测资料的分析
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毛丹怡 , 李子川 , 谢旖欣 , 金东辉 *, *
中国公共卫生 | 调查报告与分析 2025,41(10): 1220-1225
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中国公共卫生 |调查报告与分析 2025 , 41 (10) : 1220 -1225
2014—2023年湖南省居民临终地点及变化趋势：基于死因监测资料的分析
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毛丹怡, 李子川, 谢旖欣, 金东辉*, *
作者信息
  • 湖南省疾病预防控制中心，长沙 410005
通讯作者:
金东辉，E-mail：
作者简介:

毛丹怡（1999—），硕士，研究方向：卫生统计

Places of death and changing trends of residents in Hunan province from 2014 to 2023: an analysis based on cause-of-death surveillance data
Danyi MAO, Zichuan LI, Yixin XIE, Donghui JIN
Affiliations
  • Hunan Provincial Center for Disease Control and Prevention, Changsha 410005, China
    • Corresponding Author:
    JIN Donghui, E-mail:
出版时间: 2025-10-10 doi: 10.11847/zgggws1147314
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摘要
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目的

分析2014—2023年湖南省居民临终地点变化趋势，为构建符合国情的临终关怀服务体系提供实证依据。

方法

收集2014—2023年湖南省死因监测数据，以2020年湖南省人口普查数据为标准人口，计算经年龄标准化的临终地点构成比，采用Joinpoint回归模型分析不同临终地点的变化趋势。

结果

2014—2023年，湖南省登记死亡人口中居家临终占比81.18%、年均上升0.40%（AAPC=0.40%，P<0.001）；医疗机构临终构成比呈现先降（2014—2017年APC= −2.49%，P=0.020）后升（2017—2023年APC=1.55%，P<0.001）；养老机构临终构成比年均增长8.59%（AAPC=8.59%，P<0.001）；来院途中临终构成比年均下降4.32%（AAPC= −4.32%，P<0.001）。2014—2023年，湖南省医疗机构临终构成比农村（8.52%）与城市（19.69%）比较差异有统计学意义（χ2=106 862.300，P<0.001），农村医疗机构临终构成比年均上升1.31%（AAPC=1.31%，P<0.001）。

结论

湖南省临终地点仍以居家为主，但医疗机构和养老机构占比快速上升，呈现机构化转型趋势。未来政策需平衡“资源公平”与“文化适配”，在提升医疗可及性的同时维护临终选择的多样性与尊严。

居民死亡  /  临终地点  /  趋势分析  /  Joinpoint回归  /  湖南省
Objective

To understand the changing trends of places of death among residents in Hunan province from 2014 to 2023 and provide an empirical basis for constructing a hospice care service system in line with national conditions.

Methods

The cause-of-death surveillance data of Hunan province from 2014 to 2023 were collected. The 2020 Hunan census data were taken as the standard population to calculate the age-standardized composition ratio of the places of death. The Joinpoint regression model was adopted to analyze the changing trend of different places of death.

Results

From 2014 to 2023, 81.18% of the registered deaths in Hunan province were dying at home, with an average annual increase of 0.40% (AAPC = 0.40%, P < 0.001). The ratio of death in hospitals first decreased (2014–2017: APC =–2.49%, P = 0.020) and then increased (2017–2023: APC = 1.55%, P < 0.001). The ratio of death in nursing institutions increased by 8.59% annually (AAPC = 8.59%, P < 0.001). The ratio of death on the way to hospitals decreased by 4.32% annually (AAPC = –4.32%, P < 0.001). From 2014 to 2023, the ratio of death in rural hospitals in Hunan province was 8.52%, which differed from that (19.69%) in urban hospitals (χ2 = 106 862.300, P < 0.001). The ratio of death in rural hospitals increased by 1.31% annually (AAPC = 1.31%, P < 0.001).

Conclusions

Home is still the dominated place of death in Hunan province, while the ratios of death in hospitals and nursing institutions are rising rapidly. Future policies should balance resource equity and cultural adaptation and improve medical access while maintaining the diversity and dignity of end-of-life choices.

resident death  /  place of death  /  trend research  /  Joinpoint regression  /  Hunan province
毛丹怡, 李子川, 谢旖欣, 金东辉. 2014—2023年湖南省居民临终地点及变化趋势：基于死因监测资料的分析. 中国公共卫生, 2025 , 41 (10) : 1220 -1225 . DOI: 10.11847/zgggws1147314
Danyi MAO, Zichuan LI, Yixin XIE, Donghui JIN. Places of death and changing trends of residents in Hunan province from 2014 to 2023: an analysis based on cause-of-death surveillance data[J]. Chinese Journal of Public Health, 2025 , 41 (10) : 1220 -1225 . DOI: 10.11847/zgggws1147314
正文
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保障临终质量是实现全生命周期健康服务的重要环节[1]。在老龄化加速与“未富先老”的双重挑战下[2]，科学规划临终服务资源配置成为公共卫生领域的紧迫课题[3]。临终地点作为衡量临终质量的核心指标之一[4–5]，其演变趋势直接反映医疗资源供给效能与社会需求匹配度[6–7]。研究发现，我国约70%的死亡发生在家中，20%在医疗机构[8–9]，整体呈现居家主导、医院比例缓升的双重态势[3,9]。然而，现有研究多基于全国数据[1,3,10–11]，省级层面的系统分析较少。基于此，本研究收集2014—2023年湖南省死因监测数据，系统分析临终地点的时序演变特征及变化规律，为构建符合国情的临终关怀服务体系提供实证依据。
1　资料与方法
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1.1　资料来源
数据来自全国死因登记报告信息系统。选取死亡时间为2014—2023年，且常住地及报告死亡地均为湖南省的数据。提取变量包括：地区（将区或市定义为城市地区，将县定义为农村地区）；人口统计学特征包括年龄（分为0～<15、15～<65、65～<85、≥85岁）；性别（男、女）、民族（汉族和其他）；婚姻状况（已婚、离婚、丧偶、未婚以及未说明）。社会经济变量包括职业（专技/职员/公务员、工人/自由职业/企业管理者、农民、离退休人员、无业/学生、其他）。受教育程度（初中及以下、高中、大学及以上）。居民临终地点则分为家中、医疗卫生机构、养老服务机构、来院途中和其他5类。本研究经湖南省疾病预防控制中心（湖南省预防医学科学院）审查批准（批号：湘疾控IRB-2025-008-01）。
1.2　质量控制
每年组织死因监测培训，严格落实《全国死因登记报告工作规范》要求，死亡个案经各级疾病预防控制中心审核。通过与人力资源和社会保障厅、公安、民政等部门合作，加强死亡人员数据比对、核查。定期分析粗死亡率、报告及时性、审核及时性、身份证填写完整性、死因链填写完整性。根本死因编码准确性等常规质量指标，严密监控全省死因监测数据质量。
1.3　统计分析
描述性分析不同临终地点的人口统计学特征，采用频数（百分比）表示分类变量。使用频数和构成比描述不同年度的临终地点死亡情况。临终地点构成比=（某临终地点某年死亡人数/当年登记总死亡数）×100%。以2020年湖南省第七次人口普查数据为标准人口，计算经年龄标准化的临终地点构成比，用以比较不同年度的结局[12]。通过Joinpoint模型计算年度变化百分率（annual percentage rate change, APC）和年平均变化百分率（average annual percentage rate change, AAPC）评价不同临终地点构成比的变化趋势[13]，模型计算经验分位数置信区间。以P<0.05为差异有统计学意义，所有检验均为双侧检验。采用R 4.2.1软件开展描述性分析、Joinpoint 5.3.0软件进行Joinpoint回归分析。
2　结　果
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2.1　不同临终地点的主要特征分布（表1）
2014—2023年，湖南省共登记死亡人数4 037 609例。其中，81.18%的死亡发生在家中，13.28%死亡发生于医疗卫生机构。在总死亡人口中，农村居民占57.40%，65岁及以上老年人占77.80%，男性占58.70%。临终人群的地区分布显示，居家的农村居民占60.80%，医疗卫生机构中城市居民占63.20%。临终人群的年龄分布表明，65～<85岁年龄组的居民在家中（54.80%）和医疗卫生机构（49.30%）死亡的占比均居首位；临终人群中居家男性占57.30%，医疗卫生机构中男性占63.90%，均超过女性比例。
2.2　不同年份不同临终地点的构成（表2）
2014—2023年湖南省居民居家临终构成比以2022年最低（79.93%）、以2017年最高（82.07%），医疗机构临终构成比以2017年最低（12.31%）、2022年最高（14.80%）。
2.3　不同临终地点的Joinpoint回归结果（表3）
2014—2023年，湖南省医疗机构、家中和养老服务机构临终构成比呈现阶段性变化特征，其中医疗机构临终构成比2014—2017年呈下降趋势（APC= −2.49%，P=0.020）；2017—2023年呈上升趋势（APC=1.55%，P<0.001）；2014—2023年年均变化趋势差异无统计学意义（AAPC=0.19%，P=0.401）。居家临终构成比2014—2017年呈上升趋势（APC=1.58%，P<0.001），2017—2023年呈下降趋势（APC= −0.19%，P=0.042）。2014—2023年居家临终的构成比年均上升0.40%（AAPC=0.40%，P<0.001）。养老服务机构临终构成比2017—2023年呈上升趋势（APC=12.66%，P<0.001），2014—2023年临终构成比年均上升8.59%（AAPC=8.59%，P<0.001）。来院途中临终构成比2014—2023年年均下降4.32%（AAPC= −4.32%，P<0.001）；2014—2023年其他地点临终构成比年均下降1.32%（AAPC= −1.32%，P=0.037）。
2.4　城乡医疗机构临终构成及趋势变化（表4～5）
2014—2023年湖南省医疗机构临终构成比农村（8.52%）与城市（19.69%）比较差异有统计学意义（χ2=106 862.300，P<0.001）。2014—2023年湖南省农村地区医疗机构临终构成比总体呈上升趋势，年均上升1.31%（AAPC=1.31%，P<0.001）。农村地区医疗机构临终构成比在2016年前后呈现趋势转变特征，其中2016—2023年变化趋势差异有统计学意义（APC=2.63%，P=0.003）；城市地区总体呈下降趋势，但无统计学意义（AAPC= −0.74%，P=0.180）。
3　讨　论
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2014—2023年湖南省登记死亡人口中居家临终占比81.18%，总体呈现上升趋势，年均增幅0.40%（AAPC=0.40%，P<0.001）。虽然2017—2023年呈现下降趋势（APC= −0.19%，P=0.042），但仍持续处于高位水平。该现象并非湖南省特例，高居家临终占比在我国呈现共性特征，多项基于全国样本的研究与该结论一致[1,3]。相较于发达国家（如英国、美国）居家死亡比例低于30%的情况[14–15]。这一趋势与我国“落叶归根”的文化传统及老年群体居家临终偏好高度吻合[3,11]。数据显示[16]，湖南省2022年65岁以上人口规模达1 065万人（占比16.13%）。人口老龄化进程加速叠加医疗资源分布不均衡的客观现实，共同推高了湖南省居家临终比例[10]。具体而言，尽管基层医疗卫生机构能力提升（如村卫生室覆盖），但农村地区医疗资源仍相对匮乏，加之传统观念影响，促使家中成为临终照护的主要场所。在我国，居民在家临终有被动型和主动型的差异，其中大多数农村老年人由于医疗资源的不足，而被动在家临终[1]。此外，由于我国缺乏系统的临终关怀体系，家庭照护的“非正式性”可能进一步强化了居家临终的主导地位[11]。
值得注意的是，居家临终比例的阶段性趋势变化（2014—2017年上升、2017—2023年微降），与医疗机构临终趋势的变化相呼应。医疗机构临终构成比的AAPC虽差异无统计学意义（AAPC=0.19%，P=0.401），但Joinpoint回归结果显示，不同观察阶段的趋势特征差异有统计学意义：2014—2017年呈现下降趋势（APC= −2.49%，P=0.020），2017—2023年则呈现上升趋势（APC=1.55%，P<0.001）。医疗机构临终构成比的早期下降可能源于“落叶归根”的文化传统影响，当“60后”及更年长群体作为家庭主要决策者时，更倾向于选择居家临终[1]，这也与同期居家临终比例上升的结果相吻合。而2017—2023年医疗机构临终构成比的上升可能受到以下几个方面影响：其一，人口老龄化加剧导致慢性病终末期住院需求增加[10]；其二，医疗资源配置的结构性矛盾持续存在——虽然2015年起推行分级诊疗制度，但基层医疗机构在基层首诊、双向转诊等方面仍未达预期，加之医保支付政策对分级诊疗的激励不足，客观上强化了患者向大型医疗机构集中的趋势[17]；其三，个体就医观念中持续存在的“高就医心理”[17]；其四，受代际决策权变迁的影响，随着年轻一代逐渐参与家庭医疗决策，其医疗知识获取渠道多元化及死亡观念的理性化转变，更倾向于选择机构化临终方式[11]。此外，后疫情时代社会对临终关怀服务的需求显著增长[18–19]。但我国尚未建立规范化的居家临终关怀体系[10]，这也使得医疗机构成为获取专业护理服务的优先选择。与此同时，养老机构临终构成比呈现上升趋势（AAPC=8.59%，P<0.001），机构养老逐步成为重要临终场所[14]。但湖南省养老机构临终占比仍偏低（不足1%），提示老年人群长期照护体系建设仍需加强。来院途中临终构成比呈下降趋势（AAPC= −4.32%，P<0.001），这与上海的一项研究结果一致[20]，推测该趋势可能与急救体系完善、交通条件改善有关。
西方发达国家的临终地点演变呈现“三阶段”的特征[21]。20世纪初，受限于医疗资源匮乏，超过90%的个体在家中临终（第一阶段）；伴随医疗技术进步与医院服务体系扩张，至20世纪70年代，约80%的死亡发生在医疗机构（第二阶段）；因社会对临终尊严与人性化照护的反思，加之社区医疗支持体系的完善，在家临终比例逐步回升（第三阶段）[1,3]。临终地点总体呈现出从家中到医院再回归家中的经历。当前，大多数发达国家的临终关怀处于第二阶段或从第二阶段开始向第三阶段过渡[10]。尽管湖南省居家临终比例维持高位，但医疗机构使用率回升、养老机构快速增长，提示正步入第一阶段（居家为主导）向第二阶段（机构化）的过渡期，与一项临终地点研究中对我国整体阶段的判断一致[10]。但这种模式并非单纯由医疗技术主导，而是人口老龄化加速与医疗资源结构性错配（三甲医院过度集中与基层资源相对不足并存）的共同作用。
2014—2023年湖南省城乡医疗机构临终构成比差异有统计学意义（χ2=106 862.300，P<0.001）。从整体差异看，医疗资源分布失衡是导致该现象的根本原因——城市地区优质医疗资源高度集聚，而农村基层卫生服务仍处于薄弱状态。数据显示，城市地区医疗机构临终构成比高于农村地区，该城乡差异特征与涂丽等[1]、张立龙等[3]的研究结论相印证。除医疗资源差异外，城市人群相对较高的教育水平及经济能力等因素亦具有潜在影响[22]。从动态趋势看，农村地区医疗机构临终构成比呈现上升趋势（AAPC=1.31%，P<0.001），而城市地区暂未观察到显著趋势变化（AAPC= −0.74%，P=0.180）。这一趋势与张立龙等[3]关于“中国农村老年人临终地点正经历从家庭到医疗机构转变的阶段”的预测结果一致。同时，这一趋势还可能源于湖南省加强基层医疗卫生服务能力的政策措施，使得农村的医疗机构临终可及性得到提升[23]。
结果表明，2014—2023年，湖南省临终地点分布具有如下特征：仍以居家临终为主流（年均增长0.40%）；医疗机构临终构成比呈现先降后升（2017年后年均增长1.55%），养老机构临终构成比快速上升（年均增长8.59%），来院途中死亡持续下降（年均下降4.32%）；城乡医疗机构临终构成比差异有统计学意义。农村医疗机构临终构成比呈现持续上升（年均增长1.31%），城市地区暂未观察到显著趋势变化。推测湖南省临终地点发展处于第一阶段（居家主导）向第二阶段（机构化）的过渡期，其驱动机制源于老龄化加速与医疗资源错配的叠加作用。基于此，建议如下：（1）加强居家临终服务保障。推广“家庭病床”和上门医疗服务，完善相关医保报销制度，让更多家庭能放心主动选择居家临终，减轻医疗机构负担。（2）提升养老机构服务水平。制定全省统一的安宁疗护服务标准，严格把关从业人员资质，定期开展专业技能培训，确保养老机构提供规范的临终关怀。（3）优化区域医疗资源均衡配置。严格落实分级诊疗制度，引导常见病、慢性病患者到基层医疗机构就诊，重点支持医疗薄弱地区，减少不同市、区之间的资源差距。（4）提升农村服务能力。加强村卫生室建设和对乡村医生的培训，提升乡镇卫生院的临终照护能力，探索“县—乡—村”三级临终照护网络。（5）引导居民科学选择场所。通过社区宣传、案例展示等方式，让居民了解不同临终场所的特点，引导居民合理选择临终场所。

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doi: 10.11847/zgggws1147314
  • 接收时间：2025-03-25
  • 首发时间：2026-10-25
  • 出版时间：2025-10-10
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  • 收稿日期：2025-03-25
  • 修回日期：2025-07-27
  • 录用日期：2025-09-26
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    湖南省疾病预防控制中心，长沙 410005

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
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