Does place of death from lung, colorectal, breast, and prostate cancer vary between ethnic groups?
Victoria Coupland, Peter Madden, Ruth Jack, Henrik Mller, Elizabeth Davies
King's College London, London, UK
Background
The
NHS End of Life Care Strategy seeks to ensure that all groups in society have
equal access to palliative care services. This study investigated whether
place of death from cancer differed between ethnic groups in South East
England.
Method
Data
on 101,516 patients dying from lung, colorectal, breast, and prostate cancer
between 1998 and 2006 were extracted from the Thames Cancer Registry database.
Ethnicity was classified primarily using self-assigned information from linked
Hospital Episode Statistics data. Two logistic regression models were fitted;
death in hospice versus death elsewhere and death at home versus death
elsewhere, comparing individual ethnic groups with the White population.
Adjustment was made for age at death, deprivation, cancer network of residence,
and time between diagnosis and death.
Results
Ethnicity
information was available for 68,804 patients (68%). Following adjustment,
hospice deaths were significantly less likely for Pakistani patients (OR=0.47
95%CI [0.30-0.74]), Indian patients (0.68 [0.55-0.84]), and Bangladeshi
patients (0.33 [0.19-0.56]). Black African, Black Caribbean, and Chinese
patients, however, were as likely as White patients to die in a hospice.
Deaths at home were significantly less likely for 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]). The three Asian groups (Pakistani, Indian, and
Bangladeshi) were as likely as White patients to die at home.
Conclusion
These
findings show that ethnicity may influence where individuals die. Further
studies are needed to determine whether these results reflect differences in
preferences for place of death or barriers to access to specialist care in
different settings.
