title: Is individual educational level related to end-of-life care use? Results from a nationwide retrospective cohort study in Belgium.
abstract: BACKGROUND
  Educational level has repeatedly been identified as an important determinant of access to health care, but little is known about its influence on end-of-life care use.
  
  
  OBJECTIVE
  To examine the relationship between individual educational attainment and end-of-life care use and to assess the importance of individual educational attainment in explaining differential end-of-life care use.
  
  
  METHODS
  A retrospective cohort study via a nationwide sentinel network of general practitioners (GPs; SENTI-MELC Study) provided data on end-of-life care utilization. Multilevel analysis was used to model the association between educational level and health care use, adjusting for individual and contextual confounders based upon Andersen's behavioral model of health services use.
  
  
  METHODS
  A Belgian nationwide representative sample of people who died not suddenly in 2005-2007.
  
  
  RESULTS
  In comparison to their less educated counterparts, higher educated people equally often had a palliative treatment goal but more often used multidisciplinary palliative care services (odds ratios [OR] for lower secondary education 1.28 [1.04-1.59] and for higher [secondary] education: 1.31 [1.02-1.68]), moved between care settings more frequently (OR: 1.68 [1.13-2.48] for lower secondary education and 1.51 [0.93-2.48] for higher [secondary] education) and had more contacts with the GP in the final 3 months of life.
  
  
  CONCLUSIONS
  Less well-educated people appear to be disadvantaged in terms of access to specialist palliative care services, and GP contacts at the end of life, suggesting a need for empowerment of less well-educated terminally ill people regarding specialist palliative and general end-of-life care use.
authors.affiliation: Scientific Institute of Public Health, Operational Directorate Public Health & Surveillance, Brussels, Belgium. nathalie.bossuyt@wiv-isp.be
authors.forename: Nathalie
authors.initials: N
authors.lastname: Bossuyt
authors.forename: Lieve
authors.initials: L
authors.lastname: Van den Block
authors.forename: Joachim
authors.initials: J
authors.lastname: Cohen
authors.forename: Koen
authors.initials: K
authors.lastname: Meeussen
authors.forename: Johan
authors.initials: J
authors.lastname: Bilsen
authors.forename: Michael
authors.initials: M
authors.lastname: Echteld
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
authors.forename: Viviane
authors.initials: V
authors.lastname: Van Casteren
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D001530:Belgium; D002648:Child; D002675:Child, Preschool; D004521:Educational Measurement / Q000379:methods / Q000706:statistics & numerical data*; D004522:Educational Status; D005260:Female; D006291:Health Policy; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D015999:Multivariate Analysis; D016017:Odds Ratio; D010166:Palliative Care / Q000379:methods*; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D013727:Terminal Care / Q000379:methods*; D055815:Young Adult