Social determinants of where people die: A study of moderators and mediators using linked UK Census and mortality data

IF 3.6 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Ssm-Population Health Pub Date : 2025-03-21 DOI:10.1016/j.ssmph.2025.101784

J.M. Davies , K.C. Chua , M. Maddocks , F.E.M. Murtagh , K.E. Sleeman

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引用次数: 0

Abstract

Background

Where people die depends on many factors and is important to the quality of end-of-life care. Many people prefer to avoid end-of-life hospital admissions and yet hospital remains the most common place of death across high-income countries and is more likely for people who live in more deprived areas. This study examines moderators and mediators of socioeconomic inequality in place of death.

Methods

We used census data linked to mortality data for people who died in England and Wales between 2011 and 2017 to investigate the association between area-based income deprivation and death in hospital versus home, hospice, and care home. We tested moderators including age, sex, ethnicity, underlying cause of death and region, and mediating pathways through housing deprivation, living alone, and worse health.

Results

Among 34,230 decedents, after adjusting for age and sex, the proportion of deaths in hospital was higher in more deprived areas; 52.4 % (95 % CI: 51.2 %–53.6 %) and 46.7 % (45.5 %–48.0 %) for people living in the most and least deprived areas, respectively. This association was moderated by underlying cause of death; a social gradient was observed for deaths from cancer, dementia and ‘other’ causes but not for people who died from respiratory, cardiovascular, and sudden causes (F = 43.81; df (20), p = 0.0016). In a subsample of people who died from cancer, people living in the most deprived areas were more likely to live alone (36 % (95 % CI 30 %–41 %)) than those in the least deprived areas (19 % (15 %–23 %)), and this partly explained why they were more likely to die in hospital, accounting for 12.2 % of the total effect of income deprivation on death in hospital.

Conclusion

This study contributes novel findings that deepen our understanding of socioeconomic inequality in place of death. Improving support for people living alone in more deprived areas is identified as a potential way to reduce inequalities in place of death.

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来源期刊

Ssm-Population Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

6.50

自引率

2.10%

发文量

298

审稿时长

101 days

期刊介绍： SSM - Population Health. The new online only, open access, peer reviewed journal in all areas relating Social Science research to population health. SSM - Population Health shares the same Editors-in Chief and general approach to manuscripts as its sister journal, Social Science & Medicine. The journal takes a broad approach to the field especially welcoming interdisciplinary papers from across the Social Sciences and allied areas. SSM - Population Health offers an alternative outlet for work which might not be considered, or is classed as ''out of scope'' elsewhere, and prioritizes fast peer review and publication to the benefit of authors and readers. The journal welcomes all types of paper from traditional primary research articles, replication studies, short communications, methodological studies, instrument validation, opinion pieces, literature reviews, etc. SSM - Population Health also offers the opportunity to publish special issues or sections to reflect current interest and research in topical or developing areas. The journal fully supports authors wanting to present their research in an innovative fashion though the use of multimedia formats.