Introduction Place of death is a metric used for planning and monitoring palliative care (PC). The COVID-19 pandemic has seen a significant increase in cancer deaths at home.
Aims To determine whether pandemic increases in the percentage of cancer deaths at home differ by ethnic group
Methods Data source: death registrations in England, 2018 to 2021 with underlying cause of death cancer (ICD-10 C00-C97). Ethnic group derived from linked hospital episode data. The age and deprivation distribution across ethnic groups varies and each has a strong independent effect on place of death. so, calculated percentage deaths at home were standardised by these factors to make them comparable. Analysis concentrated on the largest ethnic groups: White, Asian/Asian British (Asian), and Black/African/Caribbean/Black British (Black). Comparisons were made between time periods by analysis of the ratio of percentages 2020–2021 (COVID-19 Pandemic) vs 2018–2019 (Baseline).
Results For each ethnic group the age-standardised percentage of cancer deaths at home significantly increased (P < 0.05) from 2018–2019 to 2020–2021
Asian: 33.5%, 47.5%
Black: 28.8%, 39.0%
White: 30.7%, 41.2%
The ratio of standardised percentage of deaths at home (95% CI) was
Asian: 1.42 (1.36,1.48 )
Black: 1.35 (1.27, 1.44)
White 1.34 (1.33, 1.35)
Conclusions Cancer deaths at home increased by > 10 percentage points during the pandemic for Asians, Blacks and Whites. Significant differences between ethnic groups before the pandemic (2018–19) persisted with Asians more likely than Whites, and Blacks less likely than Whites to die at home. The largest increase was for Asians, the group with the highest pre-pandemic home deaths.
Impact These ethnic differences merit investigation regarding cultural preferences, access issues and quality of PC experience. Community health and PC teams need additional resources and training in culturally sensitive care to support the increased number of ethnically diverse cancer patients dying at home.
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