They say money makes the world go around and it turns out wealth also plays a critical role in the level of end-of-life care Australians receive.
An analysis of end-of-life care in wealthy countries, including Australia, found that poorer people are more likely to receive low-quality end-of-life care, as well as being more likely to die in hospital, rather than at home, than those from wealthy backgrounds.
The research, published in the PLOS Medicine Journal by researchers from King’s College London, shows lower socioeconomic position (SEP) is a known risk factor for reduced life expectancy and earlier onset of diseases, but little is known about the role these SEP factors play in end-of-life care.
Researchers analysed 209 studies from North America, Europe, Australia and Asia to see if there was a link between SEP factors – including income, education, occupation, private medical insurance status, housing tenure and housing quality – with healthcare received by adults in their last year of life.
They looked at whether these factors impacted where people died, the quality of care they received, whether or not they received acute care, palliative care and nonspecialist end-of-life care and if they used advanced care planning.
It was revealed that people living in the most deprived neighbourhoods were more likely to die in hospital than in their home. The research also showed they were more likely to receive acute hospital-based care in the last three months of life, while they were less likely to receive specialist palliative care.
Those with the lowest levels of education were also less likely to receive specialist palliative care – which is known to reduce symptoms and improve wellbeing at the end of life.
“These findings should stimulate widespread efforts to reduce socioeconomic inequality towards the end of life,” the study authors wrote.
“We recommend that all research on care received towards the end of life should attempt to account for SEP; end of life care interventions should be analysed for their different effects across the social strata; and the planning and provision of end of life care services should consider SEP in local populations.”
Researchers concluded that, despite the observational nature of the study, there is consistent evidence of socioeconomic inequality in the care received by people as they approach the end of life. They described social inequality in health status and quality of healthcare received as a “global phenomenon” and that people with lower SEP are more likely to experience worse care.
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