LB73

A population-based study of time trends and socio-economic variations in place of death of lung cancer patients in Ireland: 1994 - 2005

Perrine Foll, Anne-Elie Carsin, Sandra Deady, Christine Buicke, Linda Sharp

National Cancer Registry Ireland, Cork, Ireland

Background
Lung cancer accounts for more cancer-related deaths in Europe than any other type of cancer, and patient prognosis is generally poor. In recent years there has been a major expansion in palliative care services and hospice provision in many countries, including Ireland. The extent to which this has impacted on where people with cancer die had been relatively little investigated. We investigated time trends and socio-demographic factors associated with place of death for patients with lung cancer in Ireland in 1994-2005.

Method
We included all 18,078 death certificates with lung cancer as the primary/underlying cause of death during 1994-2005. Place of death was categorised as: home, acute hospital, nursing home, hospice, or unknown. Time trends were assessed by joinpoint regression. Factors associated with place of death were investigated using logistic regression (home/hospice/nursing home vs hospital).

Results
Overall 53% of patients died in hospital, 29% at home, 12% in hospices and 4% in nursing homes. The percentage of home deaths fell slightly over time (-2.2% per annum, 95% CI -3.0% to -1.4%), while nursing home deaths rose (+6.1% per annum, 3.0%-9.3%). Hospice deaths increased from 7% in 1994 to 15% in 2002-03, but fell slightly in 2004-5. In multivariate models, compared to hospital deaths, home deaths were more likely to be younger, female and not married. Those who died in hospices were younger than those who died in hospital, and strong geographical variations were evident. Nursing home deaths were older, female, married and more likely to be of higher socio-economic status compared to hospital deaths.

Conclusion
The observed variations in place of death by age, sex, area and socio-economic status are unlikely to be entirely due to differences in patient preferences. The apparent recent decline in hospice deaths requires further investigation in light of developments in palliative services in Ireland.