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14-03-2012 | General practice | Article

Socioeconomic position influences cancer patients’ place of death


Free abstract

MedWire News: Age, income, and social class have been linked to whether cancer patients die at home or at an institution in research published in BMJ Supportive & Palliative Care.

"A clear majority of terminally ill patients and their relatives prefer palliative care and death to take place at home, and accordingly dying at home has been found positively associated with bereaved relative's positive evaluation of the palliative trajectory… Dying at home has also been found positively associated with home visits by the GP [general practitioner] during the palliative trajectory," explain Mette Asbjoern Neergaard and colleagues of Aarhus University Hospital, Denmark.

" However, we do not know whether this association with the probability of dying at home is also mediated by patient-related socioeconomic factors."

The study involved 592 cancer patients (median age 71.5 years) who died between 1 March and 30 November 2006 and were registered with a GP. Data on these patients were obtained from the Danish Register of Causes of Death. Of this sample, 56.4% of the patients died at home, including nursing homes, and 50.6% had lower secondary school as their highest level of education.

Patients who qualified as "high income" had a personal annual income of over £ 20,000 (US$31,400.22; Eur€ 24,079.73) and accounted for 37.5% of the cohort, 56.5% were classed as having a "medium income" (£ 10,000-20,000 [US$ 15,700-31,400; € 12,039-24,079]), and 6.0% had a "low income" (less than £ 10,000 [US$ 15,700; € 12,039]). The majority of patients were old age or early retirement pensioners (69.3%), as opposed to being unemployed/ a student/ receiving social security, being employed, or in an academic or leadership position.

The researchers found that dying at home was significantly less common in patients aged 70-79 years or 50-59 years, compared with those aged older than 80 years. A home death was also negatively associated with having a medium income rather than a high income (prevalence ratio [PR]=0.86), and being employed or in a leadership position compared with being unemployed or a student, or receiving social security (PR=0.72).

"Thus, a socioeconomic difference was found among those cancer patients who died at home," write the researchers. "Whether this is a result of the socioeconomic status itself, or a social driven inequity in the way the healthcare system provides support to die at home, remains unknown from this cross-sectional study."

They conclude that their research shows that age, income, and social class "must be taken into account when health professionals and politicians plan palliative care services and engage in fulfilling preferences of dying at home," and call for focus on, and awareness of this issue.

By Chloe McIvor

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