The changing demographics of inpatient hospice death: Population-based cross-sectional study in England, 1993-2012

Palliat Med. 2016 Jan;30(1):45-53. doi: 10.1177/0269216315585064. Epub 2015 May 19.


Background: Studies in the United Kingdom and elsewhere have suggested inequality of hospice provision with respect to factors such as age, diagnosis and socio-economic position. How this has changed over time is unknown.

Aim: To describe the factors associated with inpatient hospice death in England and examine how these have changed over time.

Design: Population-based study. Multivariable Poisson regression compared 1998-2002, 2003-2007 and 2008-2012, with 1993-1997. Explanatory variables included individual factors (age, gender, marital status, underlying cause of death) and area-based measures of deprivation.

Setting: Adults aged 25 years and over who died in inpatient hospice units in England between 1993 and 2002 (n = 446,615).

Results: The annual number of hospice deaths increased from 17,440 in 1993 to 26,032 in 2012, accounting for 3.4% of all deaths in 1993 and 6.0% in 2012. A total of 50.6% of hospice decedents were men; the mean age was 69.9 (standard deviation: 12.4) years. The likelihood of hospice decedents being in the oldest age group (>85 years) increased over time (proportion ratio: 1.43, 95% confidence interval: 1.39 to 1.48 for 2008-2012 compared to 1993-1997). Just 5.2% of all hospice decedents had non-cancer diagnoses, though the likelihood of non-cancer conditions increased over time (proportion ratio: 1.41, 95% confidence interval: 1.37 to 1.46 for 2008-2012 compared to 1993-1997). The likelihood of hospice decedents being resident in the least deprived quintile increased over time (proportion ratio: 1.25, 95% confidence interval: 1.22 to 1.29 for 2008-2012 compared to 1993-1997).

Conclusion: The increase in non-cancer conditions among hospice decedents is encouraging although absolute numbers remain very small. Deprivation trends are concerning and require further exploration.

Keywords: Palliative care; death; hospices; terminal care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cross-Sectional Studies
  • Databases, Factual
  • Demography*
  • England / epidemiology
  • Female
  • Hospices*
  • Hospital Mortality / trends*
  • Humans
  • Male
  • Middle Aged
  • Poisson Distribution
  • Terminal Care