Does place of death from lung, colorectal, breast, and prostate cancer vary between ethnic groups?


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Victoria Coupland, Peter Madden, Ruth Jack, Henrik Mller, Elizabeth Davies

King's College London, London, UK

Abstract

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.