EAPC Atlas of Palliative Care in Europe 2019

POPULATION AND METHODS
Palliative Care needs across Europe of those who
die with serious health related suffering every year
B
For the ATLAS we estimate the people affected by serious
health-related suffering who die every year in Europe and
each European country Including only those who die in a given
year with life threatening or life-limiting health conditions.
Worldwide, estimates of palliative care needs are been studied
with concern. Global population is increasingly aging and therefore
have been generating an increased prevalence of non-communicable
diseases and the persistence of other chronic and
infectious diseases (WHA 67.19, WHO, 2014 NCDS). This population
in need of palliative care is estimated to rise significantly in
the future at the global level.
In this ATLAS the need of palliative care for adults was calculated
adapting the conceptual framework for measuring the global
burden of serious health-related suffering (SHS) of the Lancet
Commission Report on Palliative Care and Pain Relief (Knaul FM
et al, 2017). SHS is defined as suffering associated with a need
for palliative care. The work of the Commission estimated the
global burden using mortality data for 20 conditions, adjusted
for the prevalence of both physical and psychosocial symptoms
that cause most of the burden of SHS.
Based on this burden of symptoms they calculate a multiplier for
each condition to estimate the proportion of patients with that condition
who can benefit from palliative care. The multiplier refers to
the percentage applied to the total number of deaths in each condition
in order to calculate the number of decedents who need palliative
care including both those who die in a given year and those who
live with life-threatening or life-limiting health conditions.
For the ATLAS, considering only those who died with life threatening
or life-limiting health conditions in 2014, we calculate
the people who died in a year experiencing serious health-related
suffering for each country of Europe. We took as reference
the same health conditions most often generating Palliative Care
need proposed by the Lancet Commission. We retrieved data on
mortality of each condition from the WHO European Mortality
Database (EMD). Due to different denominations for conditions
in in the EMD, some conditions were excluded from the count
(malnutrition, injury, birth trauma-low birth weight, prematurity
and renal failure). Then, we apply the Lancet Commission multiplier
obtaining the population in need of palliative care for each
condition in every European Country.
We use the 2014 data of the database as for being the most complete
and recent one. For countries without data in that year
(Albania, Azerbaijan, Ireland, Monaco, Montenegro, Russian Federation,
Switzerland, Tajikistan, Macedonia and Turkmenistan) we
estimated the need using neighbour’s country’s data as a proxy.
We categorised countries within the Region in HIC and LMIC to calculate
the need of palliative care for children following the Lancet
Commission’s estimation of the proportion of children of the total
who die every year that need palliative care. In low-middle income
countries, this represents 12%, and in high-income countries, 0.6%.
The need of palliative care for the total population and only for
children who die in a given year is presented by country and
breakdown to disease group.
The ATLAS estimates that over 4,4 million people who died in
2014 in Europe experienced serious health-related suffering and
need Palliative Care
Over 139.000 children who die every year need palliative care.
People who died in 2014 in Europe needing Palliative Care
l Diseases of the circulatory system
25,65%
l Malignant neoplasm of lymphoid
and haematopoietic tissue
2,86%
l Congenital malformations and
chromosomal abnormalitites
0,36%
l Alzheimer’s disease and
other degenerative diseases
of the nervous system
2,45%
l Diseases of the musculoskeletal
system and connective tissue
0,51%
l Diseases of the respiratory system
6,36%
l Pneumonia
1,92%
DCS
MNLHT
CMCA DMSCT
MN
4,468,623 people
who die in need
of Pallliative Care
in 2014
DRS
P
M
CLDC
IHD
CLRD AH
DDS
CD
EAPC Atlas of Palliative Care in Europe
33
T
l Malignant neoplasms
37,52%
l Tuberculosis
0,35%
l Cerebrovascular disease
10,80%
l AIDS/HIV
0,24%
l Chronic liver disease and cirrhosis
2,46%
l Diseases of the digestive system
2,31%
l Ischaemic heart disease
1,51%
l Chronic lower respiratory diseases
4,70%
l Meningitis
0,01%