Introduction Despite the benefits and growing acceptance that palliative care should be made available to seriously ill, frail and dying people (Kavalieratos et al. 2016, Singer et al. 2016), for some, this is still not the case. This study used historical routine data to determine the factors associatedwith not receiving palliative care.

Methods Four electronic healthcare databases (Discharge Abstract Database recording Hospital care, Emergency Department Database, PARIS community care database, Palliative Care patient registry database) were linked for all deceased patients over 2 years in a suburban population of 200,000 in Vancouver, Canada.

Results 2504 deceased individuals were identified. Of these, 2424 patients could be linked and assigned to a leading cause of death (761 cancer, 689 dementia/frailty, 974 organ failure). 67% of all patients had a record of receiving palliative care, however, almost half of these received less than 56 days of palliative care.

For people facing end of life illness, factors increasing the risk of not being offered palliative care were:

• No attachment to a general practitioner,

• Organ failure/non–malignant diagnoses,

• Males with organ failure/non–malignant diagnoses,

• Very low median household income and,

• Patients with dementia living at home.

Conclusion With the use of routine data it is possible to proactively identify and respond to patients in high-risk categories, reducing reliance on referral by clinicians. Routine data can be used to predict the palliative care needs of specific geographical areas.