Observational studyThe Lancet. Public health2021
Socioeconomic position and use of hospital-based care towards the end of life: a mediation analysis using the English Longitudinal Study of Ageing.
Observational study in The Lancet. Public health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers.
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Who cites it
29 citing papers in PubMed.
- Socioeconomic differences in the intensity of end-of-life care among patients with cancer: a population-based study in the Lazio region, Italy.European journal of public health · 2026Observational
- Article
- Mechanisms linking family socioeconomic status to children's depressive symptoms: a longitudinal moderated mediation analysis.Child and adolescent psychiatry and mental health · 2026Article
- The inverse palliative care law in advanced lung disease: a mixed-methods systematic review and meta-analysis.EClinicalMedicine · 2026Article
- Characteristics of older people who experience high-cost hospital care at the end of life and report low-satisfaction: Evidence of low-value care from bereaved carer surveys in England.Palliative care and social practice · 2026Article
- Social determinants of where people die: A study of moderators and mediators using linked UK Census and mortality data.SSM - population health · 2025Article
- Wealth Disparities in End-of-Life Symptom Burden Among Older Adults.JAMA network open · 2025Article
- Article
- Providing 'professionalism with compassion'; how the time for caring communication can improve experiences at the end-of-life at home, findings from a realist evaluation.BMC palliative care · 2024Article
- Prenatal exposure to green space and mental health in early adolescence: findings from the TRAILS study.American journal of epidemiology · 2024Article
- Integration of primary care and palliative care services to improve equality and equity at the end-of-life: Findings from realist stakeholder workshops.Palliative medicine · 2024Article
- Social connection and end-of-life outcomes among older people in 19 countries: a population-based longitudinal study.The lancet. Healthy longevity · 2024Article
- Effect of ethnicity and socioeconomic deprivation on uptake of renal supportive care and dialysis decision-making in older adults.Clinical kidney journal · 2023Article
- Hospital admissions and mortality over 20 years in community-dwelling older people: findings from the Hertfordshire Cohort Study.Aging clinical and experimental research · 2023Article
- Association between multimorbidity and informal long-term care use in China: a nationwide cohort study.BMC geriatrics · 2023Article
- The association between socioeconomic position and the symptoms and concerns of hospital inpatients seen by specialist palliative care: Analysis of routinely collected patient data.Palliative medicine · 2023Article
- Socioeconomic differences in older adults' unplanned hospital admissions: the role of health status and social network.Age and ageing · 2023Article
- Facilitating equitable access to hospice care in socially deprived areas: A mixed methods multiple case study.Palliative medicine · 2023Article
- Cross-national differences in wealth inequality in health services and caregiving used near the end of life.EClinicalMedicine · 2023Article
- Association of rurality, type of primary caregiver and place of death with end-of-life medical expenditures among the oldest-old population in China.International journal for equity in health · 2023Article
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6 authors.
Funding
Abstract
backgroundMany patients prefer to avoid hospital-based care towards the end of life, yet hospitalisation is common and more likely for people with low socioeconomic position. The reasons underlying this socioeconomic inequality are not well understood. This study investigated health, service access, and social support as potential mediating pathways between socioeconomic position and receipt of hospital-based care towards the end of life.
methodsFor this observational cohort study, we included deceased participants from the nationally representative English Longitudinal Study of Ageing of people aged 50 years or older in England. We used a multiple mediation model with age-adjusted and gender-adjusted probit regression to estimate the direct effect of socioeconomic position (measured by wealth and education) on death in hospital and three or more hospital admissions in the last 2 years of life, and the indirect effects of socioeconomic position via three mediators: health and function, access to health-care services, and social support.
findings737 participants were included (314 [42·6%] female, 423 [57·4%] male), with a median age at death of 78 years (IQR 71-85). For death in hospital, higher wealth had a direct negative effect (probit coefficient -0·16, 95% CI -0·25 to -0·06), which was not mediated by any of the pathways tested. For frequent hospital admissions, health and function mediated the effect of wealth (-0·04, -0·08 to -0·01), accounting for 34·6% of the total negative effect of higher wealth (-0·13, -0·23 to -0·02). Higher wealth was associated with better health and function (0·25, 0·18 to 0·33). Education was associated with the outcomes only indirectly via wealth.
interpretationOur findings suggest that worse health and function could partly explain why people with lower wealth have more hospital admissions, highlighting the importance of socioeconomically driven health differences in explaining patterns of hospital use towards the end of life. The findings should raise awareness about the related risk factors of low wealth and worse health for patients approaching the end of life, and strengthen calls for resource allocation to be made on the basis of health need and socioeconomic profile.
fundingDunhill Medical Trust Fellowship Grant (RTF74/0116).
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