Barratt Helen, Asaria Miqdad, Sheringham Jessica, Stone Patrick, Raine Rosalind, Cookson Richard
Senior Clinical Research Associate, Department of Applied Health Research, University College London, UK.
Research Fellow, Centre for Health Economics, University of York, UK.
J Health Serv Res Policy. 2017 Jul;22(3):149-154. doi: 10.1177/1355819616686807. Epub 2017 Jan 11.
To describe trends in socioeconomic inequality in the proportion of deaths occurring in hospital, during a period of sustained effort by the NHS in England to improve end of life care.
Whole-population, small area longitudinal study involving 5,260,871 patients of all ages who died in England from 2001/2002 to 2011/2012. Our primary measure of inequality was the slope index of inequality. This represents the estimated gap between the most and least deprived neighbourhood in England, allowing for the gradient in between. Neighbourhoods were geographic Lower Layer Super Output Areas containing about 1500 people each.
The overall proportion of patients dying in hospital decreased from 49.5% to 43.6% during the study period, after initially increasing to 52.0% in 2004/2005. There was substantial 'pro-rich' inequality, with an estimated difference of 5.95 percentage points in the proportion of people dying in hospital (confidence interval 5.26 to 6.63), comparing the most and least deprived neighbourhoods in 2011/2012. There was no significant reduction in this gap over time, either in absolute terms or relative to the mean, despite the overall reduction in the proportion of patients dying in hospital.
Efforts to reduce the proportion of patients dying in hospital in England have been successful overall but did not reduce inequality. Greater understanding of the reasons for such inequality is required before policy changes can be determined.
描述在英格兰国民医疗服务体系（NHS）持续努力改善临终关怀期间，医院死亡比例方面的社会经济不平等趋势。
进行全人群、小区域纵向研究，涉及2001/2002年至2011/2012年期间在英格兰死亡的5,260,871名各年龄段患者。我们衡量不平等的主要指标是不平等斜率指数。这代表了英格兰最贫困和最不贫困社区之间的估计差距，并考虑到两者之间的梯度变化。社区为地理上的下层超级输出区，每个区域约有1500人。
在研究期间，医院死亡患者的总体比例从49.5%降至43.6%，最初在2004/2005年升至52.0%。存在显著的“亲富”不平等现象，在2011/2012年，比较最贫困和最不贫困社区，医院死亡人群比例估计相差5.95个百分点（置信区间为5.26至6.63）。尽管医院死亡患者比例总体下降，但随着时间推移，这一差距在绝对值上或相对于均值而言均未显著缩小。
英格兰为降低医院死亡患者比例所做的努力总体上取得了成功，但并未减少不平等。在确定政策变化之前，需要更深入了解这种不平等的原因。
