title: Does place of death vary by deprivation for patients known to specialist palliative care services?
abstract: OBJECTIVE
  Referral to, and usage of, specialist palliative care (SPC) services are not equitable and social deprivation may be a contributory factor in this. Deprivation may also affect the place of death of patients with cancer. No study, however, has investigated whether inequalities persist following referral to SPC services. This study investigates whether place of death varies by deprivation for patients known to SPC services.
  
  
  METHODS
  Place of death and postcode were obtained for 485 consecutive patients known to SPC services within NHS Lothian who died in 2014-2015. From this information, deprivation quintile (DQ) was derived using the Scottish Index of Multiple Deprivation (SIMD) database and place of death compared between DQs and analysed statistically.
  
  
  RESULTS
  Across all DQs, patients known to SPC services were more likely to die in the hospice than at home or in hospital. There was, however, a small but statistically significant difference in the ratio of hospital deaths compared to hospice deaths between the DQs, with higher death rates in hospital for the most deprived compared to the least deprived and higher death rates in the hospice for the least deprived compared to the most deprived.
  
  
  CONCLUSIONS
  This study suggests that even after referral to specialist palliative care services variation in place of death by deprivation persists. Greater deprivation is associated with increased likelihood of dying in hospital and decreased likelihood of dying in a hospice, although no difference was noted for home deaths.
authors.affiliation: Marie Curie Hospice, Glasgow, UK.
authors.forename: Michael
authors.identifier: http://orcid.org/0000-0002-5419-0722
authors.initials: M
authors.lastname: Macfarlane
authors.affiliation: Marie Curie Hospice, Glasgow, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Carduff
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D003643:Death; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D017051:Hospice Care / Q000706:statistics & numerical data*; D006738:Hospices / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000451:nursing*; D010166:Palliative Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012606:Scotland
keywords: Home care; Hospice care; Hospital care; Service evaluation; Terminal care