Background Socioeconomic (SE) status can influence where patients die, although no previous studies have investigated whether this is true following referral to specialist palliative care (SPC) services. This study investigated whether SE group influenced place of death for patients known to SPC.
Methods Place of death and SE group (using postcode data from the Scottish Index of Multiple Deprivation - SIMD) were examined in 485 patients who had died and were known to SPC services within NHS Lothian. Records were excluded if patients had died in a care home or SIMD data were unavailable. A logistic regression model was fitted with place as a three level factor and SE group as a linear regressor. The significance of differences was tested by a likelihood ratio test and contrasts assessed with Wald tests.
Results Statistically significant variation (p=0.01) was found in hospital and hospice deaths between patients from the highest socioeconomic group and the lowest, although no variation was found in home deaths. Only 45% (22/49) of patients known to SPC services in the lowest SE group died in a hospice, compared to 60% (97/163) in the highest, while 28.5% (14/49) of patients known to SPC from the lowest SE group died in hospital compared to 12% (20/163) in the highest.
Conclusions Even after referral to SPC, statistically significant variation in place of death was found between patients from the highest socioeconomic group and the lowest. Patients from the highest SE group were more likely to die in a hospice and less likely to die in a hospital than patients from the lowest SE group, although no variation in home deaths was found. Further multivariate analysis and investigation of reasons for this variation are required
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