The association between socioeconomic position and the symptoms and concerns of hospital inpatients seen by specialist palliative care: Analysis of routinely collected patient data

Abstract

Background: Understanding how socioeconomic position influences the symptoms and concerns of patients approaching the end of life is important for planning more equitable care. Data on this relationship is lacking, particularly for patients with non-cancer conditions.

Aim: To analyse the association between socioeconomic position and the symptoms and concerns of older adult patients seen by specialist palliative care.

Design: Secondary analysis of cross-sectional, routinely collected electronic patient data. We used multivariable linear regression with robust standard errors, to predict scores on the three subscales of the Integrated Palliative care Outcome Scale (IPOS; physical symptoms, emotional symptoms and communication and practical concerns) based on patient level of deprivation, measured using Index of Multiple Deprivation.

Setting/participants: Consecutive inpatients aged 60 years and over, seen by specialist palliative care at two large teaching hospitals in London between 1st January 2016 and 31st December 2019.

Results: Seven thousand eight hundred and sixty patients were included, 38.3% had cancer. After adjusting for demographic and clinical characteristics, patients living in the most deprived areas had higher (worse) predicted mean scores on the communication and practical subscale than patients living in the least deprived areas, 5.38 (95% CI: 5.10, 5.65) compared to 4.82 (4.62, 5.02) respectively. This effect of deprivation diminished with increasing age. Deprivation was not associated with scores on the physical or emotional symptoms subscales.

Conclusions: Targetting resources to address practical and communication concerns could be a strategy to reduce inequalities. Further research in different hospitals and across different settings using patient centred outcome measures is needed to examine inequalities.

Keywords: Socioeconomic factors; health equity; palliative care; symptom assessment.

Figure 1.

Adjusted* regression coefficients and 95% CI for the association between patient level of area-based deprivation and Integrated Palliative care Outcome Scale (IPOS) subscales. *Analysis adjusted for: age, sex, ethnicity, living alone, diagnosis, Phase of Illness, Australia-modified. Karnofsky Performance Status and hospital site

Figure 2.

Adjusted* linear effect and 95% CI of patient level of area-based deprivation on the Integrated Palliative care Outcome Scale (IPOS) communication/practical subscale, moderated by age (figure shows that the negative effect of being less deprived on the communication/practical subscale is stronger at younger ages and not statistically significant after age 83 years) *analysis adjusted for: age, sex, ethnicity, living alone, diagnosis, Phase of Illness, Australia-modified Karnofsky Performance Status and hospital site.