Does ethnicity affect primary palliative care identification and coding? An observational retrospective cohort study.

Abstract (English)

BACKGROUND: Primary palliative care is symptom support and care for people with life-limiting illnesses incorporated within standard primary care. Early identification of needs is recommended best practice. There is limited research concerning ethnicity and primary palliative care identification and coding. AIM: To explore associations between ethnicity and primary palliative care identification and coding. DESIGN AND SETTING: A retrospective cohort study of deceased patients in England utilising anonymised primary care data extracted in February 2022. METHOD: Multilevel logistic regression was used to examine associations between ethnicity and primary palliative care records. Cox regression was used to assess time from first record to death. Differences between first palliative care codes were examined using &#x3c7;² tests. RESULTS: A total of 200 876 patients were included; 32.30% (<i>n</i> = 64 887) had a primary palliative care record. Multilevel logistic regression (<i>n</i> = 64 887) showed no statistically significant association between ethnicity and identification after adjustment for age, sex, frailty, deprivation, and diagnosis. After adjustment, a mixed-effects Cox proportional hazards model (<i>n</i> = 58 681) indicated: compared with patients from White groups, patients from Asian (hazard ratio [HR] 0.944, 95% confidence interval [CI] = 0.891 to 0.999, <i>P</i> = 0.040) and Black, African, and Caribbean groups (HR 0.925, 95% CI = 0.862 to 0.992, <i>P</i> = 0.028) survived significantly longer; and patients from 'Other' groups had significantly shorter survival (HR 1.136, 95% CI = 1.046 to 1.234, <i>P</i> = 0.002). Patients from ethnic minority groups were significantly (<i>P</i><0.001) more likely to have a first record of specialist palliative care compared with White groups. CONCLUSION: This study found no statistically significant association between ethnicity and primary palliative care identification after adjustment. However, differences were observed in survival and first palliative care activity. To ensure and monitor equitable access, ongoing improvements in palliative care identification and audits of data quality are required.