The changing demographics of inpatient hospice death: Population-based cross-sectional study in England, 1993-2012

Katherine E. Sleeman*, Joanna M. Davies, Julia Verne, Wei Gao, Irene J. Higginson

*Corresponding author for this work

    Research output: Contribution to journalReview articlepeer-review

    50 Citations (Scopus)


    Background: Studies in the United Kingdom and elsewhere have suggested inequality of hospice provision with respect to factors such as age, diagnosis and socio-economic position. How this has changed over time is unknown. Aim: To describe the factors associated with inpatient hospice death in England and examine how these have changed over time. Design: Population-based study. Multivariable Poisson regression compared 1998-2002, 2003-2007 and 2008-2012, with 1993-1997. Explanatory variables included individual factors (age, gender, marital status, underlying cause of death) and area-based measures of deprivation. Setting: Adults aged 25 years and over who died in inpatient hospice units in England between 1993 and 2002 (n = 446,615). Results: The annual number of hospice deaths increased from 17,440 in 1993 to 26,032 in 2012, accounting for 3.4% of all deaths in 1993 and 6.0% in 2012. A total of 50.6% of hospice decedents were men; the mean age was 69.9 (standard deviation: 12.4) years. The likelihood of hospice decedents being in the oldest age group (>85 years) increased over time (proportion ratio: 1.43, 95% confidence interval: 1.39 to 1.48 for 2008-2012 compared to 1993-1997). Just 5.2% of all hospice decedents had non-cancer diagnoses, though the likelihood of non-cancer conditions increased over time (proportion ratio: 1.41, 95% confidence interval: 1.37 to 1.46 for 2008-2012 compared to 1993-1997). The likelihood of hospice decedents being resident in the least deprived quintile increased over time (proportion ratio: 1.25, 95% confidence interval: 1.22 to 1.29 for 2008-2012 compared to 1993-1997). Conclusion: The increase in non-cancer conditions among hospice decedents is encouraging although absolute numbers remain very small. Deprivation trends are concerning and require further exploration.

    Original languageEnglish
    Pages (from-to)45-53
    Number of pages9
    JournalPalliative Medicine
    Issue number1
    Publication statusPublished - 1 Jan 2016

    Bibliographical note

    Funding Information:
    W.G., I.J.H. and J.V. obtained funding. The GUIDE_Care project was funded by the National Institute for Health Research Health Services and Delivery Research (NIHR HS&DR) programme (Project number 09/2000/58). Investigators were Irene Higginson, Wei Gao, Julia Verne, Myer Glickman and Barbara Gomes. Visit the HS&DR website for more information. The project is part of a larger programme investigating care at the end of life and place of death, which has support from Cicely Saunders International and NIHR. The funder of the study had no role in design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the article; and decision to submit the article for publication.

    Publisher Copyright:
    © 2015 The Author(s).


    • Palliative care
    • death
    • hospices
    • terminal care


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