Journal Article

Urban and rural differences in geographical accessibility to inpatient palliative and end-of-life (PEoLC) facilities and place of death: a national population-based study in England, UK

Polato, Giovanna, Taylor, Ros, Verne, Julia, Chukwusa, Emeka, J Higginson, Irene, Gao, Wei

2019

Overview

Background Little is known about the role of geographic access to inpatient palliative and end of life care (PEoLC) facilities in place of death and how geographic access varies by settlement (urban and rural). This study aims to fill this evidence gap. Methods Individual-level death data in 2014 (N = 430,467, aged 25 +) were extracted from the Office for National Statistics (ONS) death registry and linked to the ONS postcode directory file to derive settlement of the deceased. Drive times from patients’ place of residence to nearest inpatient PEoLC facilities were used as a proxy estimate of geographic access. A modified Poisson regression was used to examine the association between geographic access to PEoLC facilities and place of death, adjusting for patients’ socio-demographic and clinical characteristics. Two models were developed to evaluate the association between geographic access to inpatient PEoLC facilities and place of death. Model 1 compared access to hospice, for hospice deaths versus home deaths, and Model 2 compared access to hospitals, for hospital deaths versus home deaths. The magnitude of association was measured using adjusted prevalence ratios (APRs). Results We found an inverse association between drive time to hospice and hospice deaths (Model 1), with a dose–response relationship. Patients who lived more than 10 min away from inpatient PEoLC facilities in rural areas (Model 1: APR range 0.49–0.80; Model 2: APR range 0.79–0.98) and urban areas (Model 1: APR range 0.50–0.83; Model 2: APR range 0.98–0.99) were less likely to die there, compared to those who lived closer (i.e. ≤ 10 min drive time). The effects were larger in rural areas compared to urban areas. Conclusion Geographic access to inpatient PEoLC facilities is associated with where people die, with a stronger association seen for patients who lived in rural areas. The findings highlight the need for the formulation of end of life care policies/strategies that consider differences in settlements types. Findings should feed into local end of life policies and strategies of both developed and developing countries to improve equity in health care delivery for those approaching the end of life.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Aged / Aged, 80 and over / Cancer / Comparative analysis / Datasets / Death / Demographic aspects / Demographics / Developing countries / Dose-response relationship / End of life / England - epidemiology / Epidemiology / Fatalities / Female / Geographic accessibility / Geography / Health care reform / Health care services accessibility / Health Informatics / Health Promotion and Disease Prevention / Health services / Health Services Accessibility - economics / Health Services Accessibility - trends / Hospices / Human Geography / Humans / Inpatient palliative and end of life care (PEoLC) facilities / Inpatients / LDCs / Male / Medical Geography / Medical research / Medical screening / Medicine / Medicine & Public Health / Metropolitan areas / Middle Aged / Mortality / Older people / Palliation / Palliative care / Palliative Care - economics / Palliative Care - trends / Patients / Place of death / Poisson density functions / Policies / Population / Population studies / Population Surveillance / Population-based studies / Proxy / Public Health / Residence Characteristics / Rural areas / Rural health / Rural Population - trends / Rural–urban / Settlements & damages / Statistical analysis / Studies / Terminal Care - economics / Terminal Care - trends / Urban areas / Urban health / Urban Population - trends