台灣自然死者之死亡場所的變化
 
江瑞坤¹　高以信²

 
背景及目的：死亡場所常會揭示病人在生命末期在何種照顧場所之照護需求。再者，死亡場所是生命末期照護品質指標之一，也是公共衛生政策重要指標。因此，瞭解台灣死亡場所的變化，將有助於在何處推廣與增進生命末期照護。
方法：本研究依據衛生福利部統計處所公開揭露的資訊，在衛生福利統計專區，尋找死因統計類別可以獲得自2007年至2018年度死因統計的相關資訊。本研究將死亡場所分為醫療機構、住居所、長期照護或安養機構、及其他。對於不同死因，其死亡場所也有所不同。本研究僅對近年台灣十大死因作分析。
結果：自2007年至2018年死因統計中，自然死亡者為將每年度的總死亡人數扣除死亡原因為事故傷害、蓄意自我傷害（自殺）、及加害（他殺）者。整體而言，台灣自然死亡者，死亡場所為醫療機構有逐年上升的趨勢（自2007年的40.2%至2018年的53.9%，上升13.7%），在住居所死亡則有逐年下降的趨勢（自2007年的55.7%至2018年的35.1%，下降20.6%），死亡場所為長期照護或安養機構者有上升趨勢（自2014年的1.8%至2018年的3.3%，上升1.5%），及其他者（自2014年的4.4%至2018年的7.9%，上升3.5%）。
結論：台灣2007至2018年自然死之病人的死亡場所，在醫療機構死亡比例有逐年上升的趨勢，住居所有逐年下降趨勢，死亡場所為長期照護或安養機構及其他者占少數。提高社區醫療照護品質，為末期病人打造社區成為末期生命照護與死亡場所，將需要更多且優質的安寧緩和照護人力，也是全體國民共同努力的目標。
（台灣家醫誌2021; 31: 13-25）DOI: 10.3966/168232812021033101003
 
關鍵詞：死亡場所、自然死、台灣
 

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¹佛教大林慈濟醫院家庭醫學部、²台南市立醫院（委託秀傳醫療社團法人經營）家庭醫學部
受理日期：109年10月20日　　修改日期：109年12月29日　　同意刊登：110年1月4日
通訊作者：高以信　　　　　 通訊地址：台南市東區崇德路670號　　電子信箱：m2200767@gmail.com

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Changes in the Place of Natural Death in Taiwan
 
Jui-Kun Chiang1 and Yee-Hsin Kao2

 
Background/Purpose: Where people die is an important determinant of end-of-life (EOL) care for the patients and their caregivers. Dying in a hospital setting is often an indicator of poor EOL care. Tracking the changes in place of death helps improve the quality of EOL care for patients with advanced illnesses. The purpose of this study was to assess the changes in place of death from 2007 to 2018 in Taiwan.
Methods: The data were obtained from the MHW (the Ministry of Health and Welfare) Health Statics, and the top ten causes of death in Taiwan during the period from 2007 to 2018 were analyzed. The study classified the places of death into the following four categories: hospital, residence, long-term care or nursing facility, and others.
Results:Natural deaths were all-cause deaths excluding those from external causes like accidents, deliberate self-injury (suicide), and perpetrator (homicide). Hospital was the most common place of natural death with a percentage rising steadily on an annual basis from 40.2% (2007) to 53.9% (2018). The percentage of death at residence decreased from 55.7% in 2007 to 35.1% in 2018. The percentage of death in a long-term care or nursing facility reported a modest increase from 1.8% in 2014 to 3.3% in 2018.
Conclusion:The most common place of natural death was hospital, followed by residence, in Taiwan. The percentage of death in a long-term care or nursing facility was only 3.3%. Improving the quality of EOL care in Taiwan requires the joint efforts of the government and citizens.
(Taiwan J Fam Med 2021; 31: 13-25) DOI: 10.3966/168232812021033101003
 
Key words:natural death, place of death, Taiwan
 

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¹Department of Family Medicine, Dalin Tzu Chi Hospital, Dalin, Chiayi; ²Department of Family Medicine, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan, Taiwan.
Received: October 20, 2020; Revised: December 1, 2020; Accepted: January 4, 2021.