White terminal cancer patients are more likely to die at home rather than in hospital

Does place of death from cancer vary between ethnic groups in South East England?

From Palliative Medicine

There is growing evidence that the end-of-life care needs of many are not being met. Studies have found that 49% to 90% of terminally ill patients would prefer to die at home. However, in reality only around 26% of individuals in England and Wales died at home from cancer in 2007. This is the first large-scale UK study using self-assigned ethnicity information to explore variation in place of death between ethnic groups. Results revealed that Pakistani, Indian, Bangladeshi, Black African, Black Caribbean and Chinese patients were all significantly more likely than White patients to die in hospital.

Abstract

There is growing evidence that the palliative care needs of certain people, such as those from minority ethnic groups, are not being met. The aim of this study was to investigate whether place of death from cancer differs between ethnic groups. A total of 101,516 patients resident in South East England and who died from lung, colorectal, breast or prostate cancer between 1998 and 2006 were extracted from the Thames Cancer Registry database. Ethnicity data were available for 68,804 patients (68%). The odds ratios (ORs) of death from cancer in a hospice, at home or in hospital were calculated. The results were adjusted for age at death, deprivation, cancer network of residence and time between diagnosis and death. Following adjustment, death in a hospice was significantly less likely for Pakistani patients (OR¼0.47 95% CI [0.30–0.74]), Indian patients (0.68 [0.55–0.84]) and Bangladeshi patients (0.33 [0.19–0.56]). Death at home was significantly less likely in Black African patients (0.48 [0.36–0.65]), Black Caribbean patients (0.78 [0.67–0.90]) and Chinese patients (0.46 [0.28–0.76]). Pakistani, Indian, Bangladeshi, Black African, Black Caribbean and Chinese patients were all significantly more likely than White patients to die in hospital. The results were not substantially altered by recoding the unknown ethnicity group to White or using multiple imputation to assign those with a missing ethnicity an ethnic group. Place of death varies between ethnic groups. This may reflect differences in preferences for place of death or barriers to accessing specialist care in different settings. More detailed prospective qualitative studies are urgently required to determine reasons for this variation.

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Article details

Coupland, V., Madden, P., Jack, R., Moller, H., & Davies, E. (2011). Does place of death from cancer vary between ethnic groups in South East England? Palliative Medicine DOI: 10.1177/0269216310395986

     
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