Exploring differences in referrals to a hospice at home service in two socio-economically distinct areas of Manchester, UK

Palliat Med. 2010 Jun;24(4):403-9. doi: 10.1177/0269216309354032. Epub 2009 Dec 16.


In order to provide equitable access to hospice at home palliative care services, it is important to identify the socio-economic factors associated with poorer access. In this population-based study we aimed to test the inverse care law by exploring how socio-economic status and other key demographic indicators were associated with referral rates in two distinct areas (Salford and Trafford) served by the same service. Secondary data from the UK National Census 2001, North West Cancer Intelligence Service (2004) and hospice at home service referral data (2004-06) was collated for both areas. Descriptive analysis profiled electoral ward characteristics whilst simple correlations and regression modelling estimated associations with referral rates. Referral rates were lower and cancer mortality higher in the most deprived areas (Salford). Referral rates were significantly associated with deprivation, particularly multiple deprivation, but not significantly associated with cancer mortality (service model and resources available were held constant). At the population level, the socio-economic characteristics of those referred to hospice at home rather than service provision strongly predicted referral rates. This has implications for the allocation and targeting of resources and contributes important findings to future work exploring equitable access at organizational and professional levels.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • England
  • Health Services Accessibility
  • Home Care Services, Hospital-Based / statistics & numerical data*
  • Hospice Care / statistics & numerical data*
  • Humans
  • Middle Aged
  • Neoplasms / therapy*
  • Referral and Consultation / statistics & numerical data*
  • Socioeconomic Factors
  • Young Adult