Deprivation is associated with hospital conveyance among patients who are terminally ill

Hospital admissions of patients who are terminally ill can be associated with poor experiences and unwanted outcomes, such as dying away from home. While area deprivation is associated with emergency hospital admissions in the last year of life, few studies have explored the relationship between deprivation and ambulance clinicians' decisions to convey a patient to the hospital. The aim of this study is to understand the overall proportion of terminally ill patients conveyed to hospitals by paramedics in North West England, and to explore the associations between hospital conveyance and area deprivation.

This is an observational study using routinely collected ambulance data held by the North West Ambulance Service NHS Trust in England, UK. Data on adult patients (aged 18+ years) who were coded by ambulance personnel as having a terminal illness were extracted for the period from March 2021 to February 2022. Logistic regression mixed models were used to examine the associations between hospital conveyance and area deprivation. To control for confounding variables, additional data were collected on age, gender, ethnicity, location, clinical assessment codes and place of residence.

The number of calls attended by ambulance clinicians for terminally ill patients included in the analysis was 1737. Ten per cent of these calls resulted in the patient being taken to the hospital. The odds of being taken to hospital were 1.51 (95% CI 1.06 to 2.16) times greater for patients living in the 20% most deprived areas compared with those in less deprived areas, in the final model adjusted for age, gender, place of residence and the initial coded reason for the call.

This study suggests that patients with terminal illnesses living in the most deprived areas are more likely to be taken to hospital by ambulance clinicians, compared with those in less deprived areas. Overall, however, a small proportion of patients classed as terminally ill in all areas were taken to hospital. This implies that most end-of-life care provided by ambulance clinicians in this region will be in a patient's place of residence, with implications for time, resources and training.