Abstract
Background: There is much variation in hospice use with respect to geographic factors such as area-based deprivation, location of patient’s residence and proximity to services location. However, little is known about how the association between geographic access to inpatient hospice and hospice deaths varies by patients’ region of settlement.
Study aim: To examine regional differences in the association between geographic access to inpatient hospice and hospice deaths.
Methods: A regional population-based observational study in England, UK. Records of patients aged ≥ 25 years (n = 123088) who died from non-accidental causes in 2014, were extracted from the Office for National Statistics (ONS) death registry. Our cohort comprised of patients who died at home and in inpatient hospice. Decedents were allocated to each of the nine government office regions of England (London, East Midlands, West Midlands, East, Yorkshire and The Humber, South West, South East, North West and North East) through record linkage with their postcode of usual residence. We defined geographic access as a measure of drive times from patients’ residential location to the nearest inpatient hospice. A modified Poisson regression estimated the association between geographic access to hospice, comparing hospice deaths (1) versus home deaths (0). We developed nine regional specific models and adjusted for regional differences in patient’s clinical & socio-demographic characteristics. The strength of the association was estimated with adjusted Proportional Ratios (aPRs).
Findings: The percentage of deaths varied across regions (home: 86.7% in the North East to 73.0% in the South East; hospice: 13.3% in the North East to 27.0% in the South East). We found wide differences in geographic access to inpatient hospices across regions. Median drive times to hospice varied from 4.6 minutes in London to 25.9 minutes in the North East. We found a dose-response association in the East: (aPRs: 0.22–0.78); East Midlands: (aPRs: 0.33–0.63); North East (aPRs: 0.19–0.87); North West (aPRs: 0.69–0.88); South West (aPRs: 0.56–0.89) and West Midlands (aPRs: 0.28–0.92) indicating that decedents who lived further away from hospices locations (≥ 10 minutes) were less likely to die in a hospice.
Conclusion: The clear dose-response associations in six regions underscore the importance of regional specific initiatives to improve and optimise access to hospices. Commissioners and policymakers need to do more to ensure that home death is not due to limited geographic access to inpatient hospice care.
| Original language | English |
|---|---|
| Article number | e0231666 |
| Journal | PLoS ONE |
| Volume | 15 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - 17 Apr 2020 |
Bibliographical note
Funding Information: WG, IJH, JV. Obtained funding from the National Institute for Health Research, Health Services and Delivery Research Program (NIHR HS & DR, 14/19/22). This project is partly supported by the National Institute for Health Research (NIHR) Applied Research Collaborations (ARC) South London. ARC South London is part of the National Institute for Health Research (NIHR) and is a partnership between King’s Health Partners, St. George’s, University London, and St George’s Healthcare NHS Trust. The views expressed in this publication are those of the authors and not necessarily those of the National Health Service,the National Institute for Health Research, or the Department of Health. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Open Access: This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Publisher Copyright: © 2020 Chukwusa et al.
Citation: Chukwusa E, Yu P, Verne J, Taylor R, Higginson IJ, Wei G (2020) Regional variations in geographic access to inpatient hospices and Place of death: A Population-based study in England, UK. PLoS ONE 15(4): e0231666.
DOI: https://doi.org/10.1371/journal.pone.0231666