Inequalities in place of death associated with deprivation in England

Problem

Inequality is rising in the United Kingdom in multiple domains. Achieving equity in access to preferred place of death has been on the public and political agenda for decades. A majority of patients would prefer to die in their own home or a hospice, and few would choose to die in hospital. Historic data demonstrate an association between deprivation rates and inequalities in place of death. We analyse associations and trends in deprivation and location of death in England between 2015 and 2019.

Approach

We performed cross-sectional analyses of association between place of death and deprivation in England between 2015 and 2019. Data on Index of Multiple Deprivation (IMD) and place of death was obtained from publicly available Office of National Statistics datasets. Recorded death locations were: usual residence; in a hospital; in a care home; in a hospice. Associations between levels of deprivation and proportions of deaths in each location were assessed with correlation coefficients calculated using Kendall’s method, and compared over time.

Findings

The proportion of patients dying in hospital was higher in more deprived areas in both 2015 (correlation coefficient = 0.30, p < 0.001) and 2019 (correlation coefficient = 0.23, p < 0.001). The proportion of patients dying at their usual residence was lower in more deprived areas in both 2015 (correlation coefficient -0.29, p < 0.001) and 2019 (correlation coefficient = -0.24, P < 0.001). There was no correlation between the proportion of patients dying in hospice and IMD in either 2015 (correlation coefficient = -0.04, p = 0.40) or 2019 (correlation coefficient = -0.03, p = 0.51). There was no significant difference between 2015 and 2019 correlation coefficients for any of the analysed places of death.

Consequences

Inequalities in place of death associated with deprivation levels persisted from 2015 to 2019 in England. Despite few people wanting to die in hospital, there is a clear socioeconomic disparity in place of death. More research is required into long-term care availability in more deprived areas, access to those services and education surrounding preferred place of care.