The changing demographics of inpatient hospice death: population-based, cross-sectional study in England, 1993-2012

The provision of good quality and equitable end-of-life care is high on the public and political agenda. Hospice is second only to home in terms of preference for place of death and scores higher than any other setting for quality of care. However, hospices have been criticised for inequality of access with respect to age, diagnosis, and socioeconomic status. We aimed to describe the demographic characteristics associated with hospice death in England, and assessed how these characteristics have changed over time.

In this population-based study (part of the GUIDE_Care project), we included all adults older than 25 years who had died in inpatient hospices in England from 1993 to 2002. We compared deaths in 1998-2002, 2003-07, and 2008-12, with those in 1993-97 using multivariable Poisson regression. Explanatory variables included individual factors (age, sex, marital status, underlying cause of death) and measures of deprivation based on area of residence.

446 615 deaths were included. The annual number of hospice deaths increased from 17 440 in 1993 to 26 032 in 2012, accounting for 3·4% of 519 313 deaths in England in 1993, and 6·0% of 434 105 deaths in 2012. 226 188 hospice decedents (50·6%) were men (mean age 69·9 years, SD 12·4). The likelihood of hospice decedents being in the oldest age group (>85 years) increased from 1993-97 to 2008-12 (Poisson ratio 1·43, 95% CI 1·39-1·48). Only 23 258 hospice decedents (5·2%) had non-cancer diagnoses, though the likelihood of non-cancer conditions increased during the same time period (1·41, 1·37-1·46). The likelihood of hospice decedents being resident in the least deprived quintile also increased (1·25, 1·22-1·29).

Inequalities among hospice decedents by diagnosis have decreased, although the absolute numbers of non-cancer diagnoses remain very small. Trends in deprivation are concerning, and require further exploration.

The GUIDE_Care project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme (project number 09/2000/58).