title: A population-based study of age inequalities in access to palliative care among cancer patients.
abstract: BACKGROUND
  Inequalities in access to palliative care programs (PCP) by age have been shown to exist in Canada and elsewhere. Few studies have been able to provide greater insight by simultaneously adjusting for multiple demographic, health service, and socio-cultural indicators.
  
  
  OBJECTIVE
  To re-examine the relationship between age and registration to specialized community-based PCP programs among cancer patients and identify the multiple indicators contributing to these inequalities.
  
  
  METHODS
  This retrospective, population-based study was a secondary data analysis of linked individual level information extracted from 6 administrative health databases and contextual (neighborhood level) data from provincial and census information. Subjects included all adults who died due to cancer between 1998 and 2003 living within 2 District Health Authorities in the province of Nova Scotia, Canada. The relationship between registration in a PCP and age was examined using hierarchical nonlinear regression modeling techniques. Identification of potential patient and ecologic contributing indicators was guided by Andersen's conceptual model of health service utilization.
  
  
  RESULTS
  Overall, 66% of 7511 subjects were registered with a PCP. Older subjects were significantly less likely than those <65 years of age to be registered with a PCP, in particular those aged 85 years and older (adjusted odds ratio: 0.4; 95% confidence interval: 0.3-0.5). Distance to the closest cancer center had a major impact on registration.
  
  
  CONCLUSIONS
  Age continues to be a significant predictor of PCP registration in Nova Scotia even after controlling for the confounding effects of many new demographic, health service, and ecologic indicators.
authors.affiliation: Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. fred.burge@dal.ca
authors.forename: Frederick I
authors.initials: FI
authors.lastname: Burge
authors.forename: Beverley J
authors.initials: BJ
authors.lastname: Lawson
authors.forename: Grace M
authors.initials: GM
authors.lastname: Johnston
authors.forename: Eva
authors.initials: E
authors.lastname: Grunfeld
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration / Q000706:statistics & numerical data; D006302:Health Services Research; D054625:Healthcare Disparities / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D009674:Nova Scotia; D010166:Palliative Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D012111:Residence Characteristics; D012189:Retrospective Studies; D012737:Sex Factors; D012944:Social Support; D012959:Socioeconomic Factors; D013727:Terminal Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D055815:Young Adult