Relationship Between Palliative Care and Location of Death Among People With Opioid Use Disorder: A Retrospective Cohort Study
Bibliographic record
Abstract
Objective People with opioid use disorder are at high risk of serious comorbidities, more likely to die from all major diseases, and their end-of-life needs remain poorly understood. We aimed to examine the relationship between receipt of palliative care across settings and the location of death among individuals with opioid use disorder. Methods We employed a population-level cohort study using health administrative databases. Our cohort was adults with opioid use disorder in Ontario, Canada, who died between July 2015 and December 2021 ( N = 11,200). Our exposure was receipt of palliative care within three years prior to the last 90 days of life (inpatient-only, outpatient, or none (reference)). Our primary outcome was the location of death in the community versus institution (reference). Results Among our decedent cohort, 5636 (50.3%) received no palliative care before their last 90 days of life, and among those who received it, only 1846 (33.2%) received any outpatient palliative care and 3718 (66.8%) received inpatient-only palliative care. After covariate adjustment, receiving inpatient-only palliative care (vs no palliative care) was associated with a 6% (RR 0.94; 95% CI 0.91, 0.98) decrease in the likelihood of community death, whereas there was no relationship between outpatient palliative care and location of death. Conclusions The association of palliative care with the location of death for people with opioid use disorder varies by setting of care. Further research is required to understand if community deaths are aligned with preferences and whether additional factors contribute to their likelihood.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".