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

• DOI: 10.1186/s12942-019-0172-1
• Publication Date: 2019-05-06T15:03:28Z
• Authors: Emeka Chukwusa; Julia Verne; Giovanna Polato; Ros Taylor; Irene J Higginson; Wei Gao
• Keywords: Proxy (statistics)

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