Abstract

Social inequality in admittance to specialised palliative care for cancer patients

A nation-wide study from the Danish Palliative Care Database.

Clinical Nurse Specialist Marianne Spile at work at Palliativ Medicinsk Afdeling, Bispebjerg Hospital.

Background

No nation-wide register-based studies have investigated socioeconomic position in relation to admittance to all specialised palliative care institutions (SPC) including hospital-based palliative care team/unit and hospice.

Aim

This study investigated whether cancer patients’ education and income were associated with admittance to SPC (hospital-based palliative care team/unit and/or hospice) using data from the entire population in Denmark.

Design

A register-based study with data from several Danish nation-wide registers. The association between admittance to SPC and education and income, respectively, was investigated using logistic regression analysis adjusting for sex, age, cancer diagnosis, geographic region and cohabiting status.

Setting/participants

The study population included all patients dying from cancer in Denmark 2010-12 (N=41,741).

Results

In the study population 45% had primary school as the highest attained education, and 6% had an academic education. Persons with an academic education were more likely to be admitted to SPC than those having completed primary school only (OR=1.69; 95% CI 1.51-1.89). According to income, persons in the highest income quartile (Q4) were more likely to be admitted to SPC than those in the lowest income quartile (Q1) (OR=1.46; 95% CI 1.37-1.56). The results, Q1 vs Q4, subdivided into hospital-based palliative care team/unit (OR=1.23 (95% CI: 1.14-1.31)) and hospice (OR=1.67 (95% CI: 1.54-1.81)) showed a stronger association for hospice.

Conclusion

This nationwide register-based study indicates that admittance to SPC was clearly associated with education and income. We believe that the observed associations indicate inequity. Initiatives to improve access for patients with low education or income should be established.

 

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