Life expectancies and incidence rates of patients under prolonged mechanical ventilation: a population-based study during 1998 to 2007 in Taiwan
1 Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, No 17, Xuzhou Road, Taipei 100, Taiwan
2 Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan 350, Taiwan
3 Institute of Public Health, School of Medicine, National Yang-Ming University, No. 155, Section 2, Linong Street, Taipei 112, Taiwan
4 Institutes of Clinical Medicine, College of Medicine National Taiwan University, No. 1, Jen Ai Road, Taipei 100, Taiwan
5 International Harvard Statistical Consulting Company, 57 Chongqing South Road, Section 1, 7F-11, Taipei 100, Taiwan
6 Department of Medical Research, National Taiwan University Hospital, No. 7, Chung Shan S. Road, Taipei 100, Taiwan
7 Department of Internal Medicine, Chia-Yi Christian Hospital, 539 Jhongsiao Road, Chiayi 600, Taiwan
8 Department of Medical Research, Chia-Yi Christian Hospital, 539 Jhongsiao Road, Chiayi 600, Taiwan
9 Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung Shan S. Road, Taipei 100, Taiwan
10 Department of Public Health, National Cheng Kung University College of Medicine, No. 1, University Road, Tainan 701, Taiwan
11 Departments of Internal Medicine and Environmental and Occupational Medicine, National Cheng Kung University Hospital, No. 138, Sheng Li Road, Tainan 704, Taiwan
Critical Care 2011, 15:R107 doi:10.1186/cc10128Published: 1 April 2011
The present study examined the median survival, life expectancies, and cumulative incidence rate (CIR) of patients undergoing prolonged mechanical ventilation (PMV) stratified by different underlying diseases.
According to the National Health Insurance Research Database of Taiwan, there were 8,906,406 individuals who obtained respiratory care during the period from 1997 to 2007. A random sample of this population was performed, and subjects who had continuously undergone mechanical ventilation for longer than 21 days were enrolled in the current study. Annual incidence rates and the CIR were calculated. After stratifying the patients according to their specific diagnoses, latent class analysis was performed to categorise PMV patients with multiple co-morbidities into several groups. The life expectancies of different groups were estimated using a semiparametric method with a hazard function based on the vital statistics of Taiwan.
The analysis of 50,481 PMV patients revealed that incidence rates increased as patients grew older and that the CIR (17 to 85 years old) increased from 0.103 in 1998 to 0.183 in 2004 before stabilising thereafter. The life expectancies of PMV patients suffering from degenerative neurological diseases, stroke, or injuries tended to be longer than those with chronic renal failure or cancer. Patients with chronic obstructive pulmonary disease survived longer than did those co-morbid with other underlying diseases, especially septicaemia/shock.
PMV provides a direct means to treat respiratory tract diseases and to sustain respiration in individuals suffering from degenerative neurological diseases, and individuals with either of these types of conditions respond better to PMV than do those with other co-morbidities. Future research is required to determine the cost-effectiveness of this treatment paradigm.