Inequalities in end-of-life palliative care by country of birth in New South Wales, Australia: a cohort study
Holger Möller A B C F , Hassan Assareh A D , Joanne M. Stubbs A , Bin Jalaludin C E and Helen M. Achat AA Epidemiology and Health Analytics, Research and Education Network, Western Sydney Local Health District, Locked Mail Bag 7118, Parramatta BC, NSW 2124, Australia. Email: joanne.stubbs@health.nsw.gov.au; helen.achat@health.nsw.gov.au
B The George Institute for Global Health, Level 5, 1 King Street, Newtown, NSW 2042, Australia.
C School of Population Health, UNSW Sydney, Kensington, NSW 2052, Australia. Email: b.jalaludin@unsw.edu.au
D Evidence Generation and Dissemination, Agency for Clinical Innovation, 1 Reserve Road, St Leonards, NSW 2065, Australia. Email: hassan.assareh@health.nsw.gov.au
E Population Health Intelligence, South Western Sydney Local Health District, Liverpool, NSW 2170, Australia.
F Corresponding author. Email: hmoeller@georgeinstitute.org.au
Australian Health Review - https://doi.org/10.1071/AH19269
Submitted: 29 November 2019 Accepted: 11 March 2020 Published online: 20 November 2020
Abstract
Objective This study investigated variation in in-hospital palliative care according to the decedent’s country of birth.
Methods A retrospective cohort study was performed of 73 469 patients who died in a New South Wales public hospital between July 2010 and June 2015 and were diagnosed with a palliative care-amenable condition. Differences in receipt of palliative care by country of birth were examined using multilevel logistic regression models adjusted for confounding.
Results In this cohort, 26 444 decedents received palliative care during their last hospital stay. In the adjusted analysis, 40% rate differences (median odds ratio 1.39; 95% confidence interval 1.31–1.51) were observed in receipt of palliative care between country of birth groups.
Conclusions There are differences in in-hospital palliative care at the end of life between population groups born in different countries living in Australia. The implementation of culturally sensitive palliative care programs may help reduce these inequalities. Further studies are needed to identify the determinants of the differences observed in this study and to investigate whether these differences persist in the community setting.
What is known about the topic? International studies have reported inequities in access to palliative care between ethnic groups.
What does this paper add? We observed differences in in-hospital palliative care between decedents from different countries of birth in New South Wales, Australia. These differences remained after adjusting for individual, area and hospital characteristics.
What are the implications for practitioners? Implementation of culturally sensitive palliative care services and targeting groups with low rates of palliative care can reduce these inequalities and improve a patient’s quality of life.
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