Joanna M. Davies|Katherine E Sleeman|Javiera Léniz|Rebecca Wilson|Irene J Higginson|Julia Verne|Matthew Maddocks|Fliss E.M. Murtagh
Socioeconomic position and use of healthcare in the last year of life: A systematic review and meta-analysis
Cicely Saunders International|King's College London|Cicely Saunders International|King's College London|Cicely Saunders International|King's College London|Cicely Saunders International|King's College London|Cicely Saunders International|King's College London|Public Health England|Cicely Saunders International|King's College London|Hull York Medical School|University of Hull|Cicely Saunders International|King's College London
low socioeconomic position sep recognized risk factor worse health outcomes socioeconomic factors influence endoflife care magnitude effect understood review aimed synthesise quantify associations measures sep use healthcare last year lifemedline embase psycinfo cinahl assia databases searched without language restrictions inception 1 february 2019 included empirical observational studies highincome countries reporting association sep eg income education occupation private medical insurance status housing tenure housing quality areabased deprivation place death plus use acute care specialist nonspecialist endoflife care advance care planning quality care last year life methodological quality evaluated using newcastleottawa quality assessment scale nos overall strength direction associations summarised sufficient comparable data available adjusted odds ratios ors pooled doseresponse metaregression performed total 209 studies included mean nos quality score 48 112 high mediumquality observational studies used metasynthesis metaanalysis 535 north america 310 europe 85 australia 70 asia compared people living least deprived neighbourhoods people living deprived neighbourhoods likely die hospital versus home 130 95 ci 123138 p 0001 receive acute hospitalbased care last 3 months life 116 95 ci 108125 p 0001 receive specialist palliative care 113 95 ci 107119 p 0001 every quintile increase area deprivation hospital versus home death likely 107 95 ci 105108 p 0001 receiving specialist palliative care likely 103 95 ci 102105 p 0001 compared educated qualifications years education completed least educated people likely receive specialist palliative care 126 95 ci 107149 p 0005 observational nature studies included focus highincome countries limit conclusions reviewin highincome countries low sep risk factor hospital death well indicators potentially poorquality endoflife care evidence dose response indicating inequality persists across social stratum findings stimulate widespread efforts reduce socioeconomic inequality towards end life