Title: Health inequalities related to ethnicity and socio-economic position at the end-of-life
Funder: The Academy of Medical Sciences

Abstract: Aim: To identify ethnic and socio-economic inequalities in palliative care access and clinical outcomes in individuals with advanced illness in the last year of life (LYOL) and determine where interventions need to be targeted to reduce inequalities. Objectives: 1.Describe inequalities related to ethnicity and socio-economic position in palliative care access and clinical outcomes in the LYOL. 2.Identify variation in access and clinical outcomes at the patient, General Practice (GP) and Clinical Commissioning Group (CCG) level and explore which variables, and their interactions, most explain variation at each level. 3.Compare methods of handling missing ethnicity data 4.Prepare a fellowship application on interventions to reduce inequalities. Background: 75% of people at the end-of-life can benefit from palliative care. Those from minority ethnic and socio-economically deprived backgrounds are less likely to access palliative care and have poorer outcomes. Assessments of how these characteristics affect access and outcomes and how these can be addressed are limited. Method: Multilevel modelling will identify variation in palliative care access and clinical outcomes according to ethnicity and deprivation, and the influence of factors at the patient, service (GP) and system-level (CCG) to determine where interventions need to be targeted to address inequalities. A linked dataset will be used which uniquely (i) links across primary, secondary, community and social care, (ii) includes data from all GP practices and specialist palliative care services in the region, and (iii) covers an ethnically and socio-economically diverse population, allowing rigorous assessment including interaction of these characteristics at different levels.

Lay abstract: Death, dying and bereavement affect everyone. Palliative care is the active whole-person care of people with life-limiting conditions to enable them to live and die as well as possible. Most people in the last year of their life will benefit from palliative care. But those from minority ethnic and poorer backgrounds may be less likely to access and benefit from palliative care services. Unfortunately, the COVID-19 pandemic has made many health inequalities worse, and this may be true for care at the end-of-life too. To reduce inequalities at the end-of-life, firstly it is important to understand if and how those from minority ethnic and poorer backgrounds are disadvantaged and secondly, how we can improve this. People living in Bradford come from diverse ethnic backgrounds, and across Bradford, Airedale, Wharfedale and Craven there are differences in how poor areas are. Across these areas there is a unique large dataset which links data from General Practices, hospitals, community care and social care. We will use this to carefully look at if and how coming from a minority ethnic group and/or poor background affects your chances of accessing palliative care and whether palliative care helps. We will also look at which factors most influence access to these services and whether the services help. This work will then inform in-depth discussions with patients and carers, people in the community, service providers and decision-makers to explore what we can do to make end-of-life care fairer and how we can best assess this for accountability.

Research activity codes: 7.2 END OF LIFE CARE
Health categories: GENERIC HEALTH RELEVANCE