Socioeconomic differences in the intensity of end-of-life care among patients with cancer: a population-based study in the Lazio region, Italy.

Abstract

The importance of assessing end-of-life (EoL) care has grown due to increased life expectancy and chronic disease prevalence. Despite awareness of holistic care, cancer patients often receive aggressive treatments that may reflect disparities influenced by socioeconomic factors. This study investigates EoL care among cancer patients in Italy, focusing on the impact of socioeconomic position (SEP). A retrospective observational study was conducted using Italian health databases, focusing on cancer patients aged 35 years and older who died between 2015 and 2019 in Lazio, Italy. SEP was assessed using educational attainment and a composite deprivation indicator at the census-section level. EoL care intensity was measured using hospitalization rates, emergency department visits, medication use, and place of death. Logistic regression models [OR (95% CI)] were used to explore socioeconomic associations with care intensity. The study included 84 936 subjects, predominantly aged over 75, with lung, colorectal, and breast cancers being the most common. During the last month of life, individuals with middle to higher educational levels (upper-middle, university degrees) had increased risks of hospitalization (OR 1.06; 95% CI: 1.02-1.10; OR 1.09; 95% CI: 1.03-1.15), anti-neoplastic therapies (OR 1.29; 95% CI: 1.21-1.38; OR 1.48; 95% CI: 1.36-1.61), and in-hospital death (OR 1.08; 95% CI: 1.03-1.12; OR 1.16; 95% CI: 1.10-1.23) and lower risks of ED admissions (OR 0.91; 95% CI: 0.87-0.94; OR 0.76; 95% CI: 0.71-0.80) and opioid therapy (OR 0.90; 95% CI: 0.86-0.94; OR 0.87; 95% CI: 0.82-0.92). Similar results were observed when using the area-based SEP indicator. Socioeconomic differences influence EoL care pathways for patients with cancer in Italy. These findings suggest complex interactions between socioeconomic factors and care preferences, highlighting the need for tailored and equitable EoL care strategies.