The impact of area deprivation on access to and utilization of health services in the last year of life: A retrospective population-based cohort study.

Background: The healthcare needs of people living in areas of high deprivation are complicated by the cumulative effect of the sociodemographic factors known to impact on health outcomes, such as income, housing and education. Of note, for people living in more deprived areas, life expectancy is shorter and the onset of chronic disease and multimorbidity occurs much earlier. While the relationship between area deprivation and access to palliative care is becoming more widely researched, the vast majority of studies to date have focused on referrals to specialist palliative care services. This is problematic given the dominant model of generalist-specialist palliative care in high-income countries which assumes that most people will have a level of palliative care need that can be managed by non-specialist palliative care services. Objective: To identify associations between area deprivation and the use of generalist and specialist palliative care services in the last year of life. Design: A retrospective population-based cohort study. Methods: People aged over 18 years who died between January 2015 and December 2020 were identified within one geographical area of Aotearoa New Zealand. Using the National Health Identifier, deaths were matched to generalist and specialist palliative care service data. Results: A significant association was found between area deprivation and health service use in the last year of life. Of note, people living in rural areas of deprivation were significantly less likely to receive a hospital (p = <0.000) or inpatient hospice admission (p = <0.000). They were also less likely to have contact with their general practitioner (p = 0.007) or experience a specialist outpatient clinic appointment (p = 0.001). Conclusion: This study has revealed inequities in health service use across generalist and specialist palliative care services for people living in areas of deprivation. Of note, findings have highlighted how rurality amplifies inequities in access to appropriate palliative care. Further research is needed to better understand the consequences of these apparent inequities.