Award Title: Understanding the number of people who die in poverty
Funder: Marie Curie

Abstract: A crude analysis of poverty risks and mortality rates suggests that around one in five people are likely to die in poverty. However, a more complete picture needs to take account of how costs and incomes change at the end of life, how pathways into poverty at the end of life develop, and how this varies for different population subgroups. This project seeks to address these issues using secondary analysis of quantitative data. A key aim will be to produce ‘headline statistics’ of the number of people dying in poverty, and in hardship, taking account of the additional costs of terminal illness. This will be accompanied by more detailed findings to
provide a deeper understanding of how the relationship between poverty and mortality differs according to key characteristics such as age, sex, ethnicity, location, and socioeconomic position. Analysis of administrative data, including mortality and life-expectancy statistics, as well as small-area data on income/poverty, will provide a starting point in comparing geographical areas with different socio-economic profiles. The relationships between poverty and mortality at an individual level will be explored in more detail using data from large household surveys, including Understanding Society and the English Longitudinal Study of Ageing. The latter includes longitudinal information on finances and is linked to mortality statistics, so will be particularly valuable for the proposed project. This analysis will likely involve multiple regression to explore associations between poverty and mortality controlling for other factors, and more complex methods such as survival analysis and selection modelling to refine these estimates. The findings will add significant value to Marie Curie’s work to address poverty and hardship at the end of life, Specifically, the research could potentially feed into the charity’s ‘Scrap Six Months’ campaign to remove restrictions on terminally ill patients’ access to benefits.

Lay Abstract: A diagnosis of terminal illness is devastating for anybody. But the impact can be compounded by the stress of financial hardship and its consequences, such as poor housing and fuel poverty. This can be further exacerbated by the (often substantial) financial impact of having a diagnosed terminal illness – whether through direct costs such as residential care and transport to hospital or, for working age people, through loss of income. This project seeks to find out just how common it is to die in poverty in the UK, particularly after being diagnosed with a terminal illness. A rough estimate based on official mortality and poverty rates suggests that around one in five people are likely to die in poverty. However, this doesn’t give us the full picture. We know that costs and income change at the end of life, and that the route into poverty is not the same for everyone who experiences financial hardship. We also need to consider the ways in which key characteristics such as age, sex, ethnicity and location might influence the risk and experience of poverty at the end of life. To address these issues, we will carry out statistical analysis using information collected routinely by the NHS and the Government on mortality rates and poverty in the UK. We will also use information from large household surveys that collect information on both health and financial circumstances, to increase our understanding of how poverty and mortality are linked in different groups within the population, and how the financial costs of ill health might vary. We hope the findings will help charities like Marie Curie continue to campaign to reduce poverty and hardship at the end of life, for example by removing restrictions on terminally ill patients’ access to benefits.

Research Activity Codes: 7.2 END OF LIFE CARE
Health Categories: GENERIC HEALTH RELEVANCE