• Palliative medicine · Sep 2019

    What socio-economic factors determine place of death for people with life-limiting illness? A systematic review and appraisal of methodological rigour.

    • Mette Asbjoern Neergaard, Anne Hostrup Brunoe, Marianne Hjorth Skorstengaard, and Mette Kjaergaard Nielsen.
    • 1 Palliative Care Team, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.
    • Palliat Med. 2019 Sep 1; 33 (8): 900-925.

    BackgroundSocio-economic factors play important roles in place of death. However, up-to-date knowledge on socio-economic determinants for place of death is warranted including analysis of collinearity between socio-economic determinants.AimTo examine associations between socio-economic determinants (social class, deprivation level in area of residence, income, education, occupation, urbanisation) and place of death among adult patients with life-limiting illnesses. Furthermore, to describe how these factors are operationalised and examined for collinearity.DesignA systematic review was performed (PROSPERO, record: CRD42018091218) and quality was assessed using the Newcastle-Ottawa Scale.Data SourcesA comprehensive search of PubMed, Embase, CINAHL, Scopus and PsycINFO was conducted for studies published from 1 January 2008 until the date of the search (23 March 2018) in English or Scandinavian languages.ResultsOf the 1599 unique citations identified, 34 studies were eligible. Dying at home was to a high degree associated with better financial situation and living in rural areas. Furthermore, hospital death was associated with a high level of deprivation in the area of residence and being employed. Regarding educational level, we found mixed and inconclusive results.ConclusionInequalities concerning place of death were found, and attention towards socio-economic inequality concerning place of death is necessary, especially in patients with a poor financial status, patients living in deprived and metropolitan areas and patients who are employed. Furthermore, we found a low degree of assessment for collinearity and adjustment of socio-economic variables. These issues should be considered in planning of future studies of socio-economic determinants for place of death.

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