Observational studyInternational journal of health geographics2019
Urban and rural differences in geographical accessibility to inpatient palliative and end-of-life (PEoLC) facilities and place of death: a national population-based study in England, UK.
Observational study in International journal of health geographics, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 4 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
32 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Unequal ends: A systematic review comparing place of death in rural, coastal and urban areas for older people with dementia to cancer.Palliative medicine · 2026Pooled it
- Geographic variations in place of death and palliative care utilisation in the last three months of life in high-income countries: a systematic review.BMC palliative care · 2025Pooled it
- A comparison of conceptual frameworks to examine health inequities in End-of-Life care.Journal of advanced nursing · 2023Pooled it
- Hospice care access inequalities: a systematic review and narrative synthesis.BMJ supportive & palliative care · 2022Pooled it
- Availability and Access to Palliative Sedation Medications in Ecuador: A National Survey of Palliative Care Physicians.International journal of environmental research and public health · 2026Article
- Factors associated with dying in hospital awaiting palliative care admission: a retrospective cohort study.BMC palliative care · 2026Article
- Palliative care in rural, remote, and northern communities: a scoping review.BMC palliative care · 2026Article
- Neighbourhood social gifting and multiple long-term conditions: a nationally representative analysis of the Scottish population aged 40-75 years.European journal of public health · 2026Article
- Strengthening care for adults with palliative care needs in high-income rural communities: a global policy environmental scan.BMC palliative care · 2025Article
- Patients potentially in need for palliative care in Germany-A regional small-area estimation based on death registry data.Research in health services & regions · 2025Article
- Telemedicine and Willingness to Die at Home in Rural and Remote Areas in Japan.Telemedicine reports · 2025Article
- Equity of access to palliative care: a scoping review.International journal for equity in health · 2024Article
- Experiences of family carers supporting older people within the last year of life in rural and remote areas in the UK.Age and ageing · 2024Article
- Accessibility to palliative care services in Colombia: an analysis of geographic disparities.BMC public health · 2024Observational
- Exploring perceived barriers to palliative and end of life care provision in South-West England: bringing together the perspectives of professionals, patients, and families.Frontiers in sociology · 2024Article
- A Nationwide Survey on the Practice of End-of-life Care Issues in Critical Care Units in India.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2023Article
- The impacts of the scope of benefits expansion on hospice care among adult decedents: a nationwide longitudinal observational study.BMC palliative care · 2023Observational
- Population-Based, Spatial Analysis of Specialised Ambulatory Palliative Care in Mecklenburg-Western Pomerania, Germany, on the Basis of Reimbursement Data.International journal of environmental research and public health · 2023Article
- Inclusion of palliative and end of life care in health strategies aimed at integrated care: a documentary analysis [version 2; peer review: 2 approved].AMRC open research · 2023Article
- Place of death among foreign-born individuals: a national population-based register study.Palliative care and social practice · 2023Article
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
backgroundLittle is known about the role of geographic access to inpatient palliative and end of life care (PEoLC) facilities in place of death and how geographic access varies by settlement (urban and rural). This study aims to fill this evidence gap.
methodsIndividual-level death data in 2014 (N = 430,467, aged 25 +) were extracted from the Office for National Statistics (ONS) death registry and linked to the ONS postcode directory file to derive settlement of the deceased. Drive times from patients' place of residence to nearest inpatient PEoLC facilities were used as a proxy estimate of geographic access. A modified Poisson regression was used to examine the association between geographic access to PEoLC facilities and place of death, adjusting for patients' socio-demographic and clinical characteristics. Two models were developed to evaluate the association between geographic access to inpatient PEoLC facilities and place of death. Model 1 compared access to hospice, for hospice deaths versus home deaths, and Model 2 compared access to hospitals, for hospital deaths versus home deaths. The magnitude of association was measured using adjusted prevalence ratios (APRs).
resultsWe found an inverse association between drive time to hospice and hospice deaths (Model 1), with a dose-response relationship. Patients who lived more than 10 min away from inpatient PEoLC facilities in rural areas (Model 1: APR range 0.49-0.80; Model 2: APR range 0.79-0.98) and urban areas (Model 1: APR range 0.50-0.83; Model 2: APR range 0.98-0.99) were less likely to die there, compared to those who lived closer (i.e. ≤ 10 min drive time). The effects were larger in rural areas compared to urban areas.
conclusionGeographic access to inpatient PEoLC facilities is associated with where people die, with a stronger association seen for patients who lived in rural areas. The findings highlight the need for the formulation of end of life care policies/strategies that consider differences in settlements types. Findings should feed into local end of life policies and strategies of both developed and developing countries to improve equity in health care delivery for those approaching the end of life.
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