title: The changing demographics of inpatient hospice death: Population-based cross-sectional study in England, 1993-2012.
abstract: 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.
  
  
  OBJECTIVE
  To describe the factors associated with inpatient hospice death in England and examine how these have changed over time.
  
  
  METHODS
  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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, King's College London, London, UK katherine.sleeman@kcl.ac.uk.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Sleeman
authors.affiliation: Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, King's College London, London, UK.
authors.forename: Joanna M
authors.initials: JM
authors.lastname: Davies
authors.affiliation: Public Health England Knowledge and Intelligence Team (South West), Durham, UK.
authors.forename: Julia
authors.initials: J
authors.lastname: Verne
authors.affiliation: Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, King's College London, London, UK.
authors.forename: Wei
authors.initials: W
authors.lastname: Gao
authors.affiliation: Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, King's College London, London, UK.
authors.forename: Irene J
authors.initials: IJ
authors.lastname: Higginson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D003710:Demography; D004739:England / Q000453:epidemiology; D005260:Female; D006738:Hospices; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016012:Poisson Distribution; D013727:Terminal Care
keywords: Palliative care; death; hospices; terminal care