Socioeconomic Status, Palliative Care, and Death at Home Among Patients With Cancer Before and During COVID-19 Article Swipe
Javaid Iqbal
,
Rahim Moineddin
,
Robert Fowler
,
Monika K. Krzyzanowska
,
Christopher M. Booth
,
James Downar
,
Jenny Lau
,
Lisa W. Le
,
Gary Rodin
,
Hsien Seow
,
Peter Tanuseputro
,
Craig C. Earle
,
Kieran L. Quinn
,
Breffni Hannon
,
Camilla Zimmermann
·
YOU?
·
· 2024
· Open Access
·
· DOI: https://doi.org/10.1001/jamanetworkopen.2024.0503
YOU?
·
· 2024
· Open Access
·
· DOI: https://doi.org/10.1001/jamanetworkopen.2024.0503
Importance The COVID-19 pandemic had a profound impact on the delivery of cancer care, but less is known about its association with place of death and delivery of specialized palliative care (SPC) and potential disparities in these outcomes. Objective To evaluate the association of the COVID-19 pandemic with death at home and SPC delivery at the end of life and to examine whether disparities in socioeconomic status exist for these outcomes. Design, Setting, and Participants In this cohort study, an interrupted time series analysis was conducted using Ontario Cancer Registry data comprising adult patients aged 18 years or older who died with cancer between the pre–COVID-19 (March 16, 2015, to March 15, 2020) and COVID-19 (March 16, 2020, to March 15, 2021) periods. The data analysis was performed between March and November 2023. Exposure COVID-19–related hospital restrictions starting March 16, 2020. Main Outcomes and Measures Outcomes were death at home and SPC delivery at the end of life (last 30 days before death). Socioeconomic status was measured using Ontario Marginalization Index area-based material deprivation quintiles, with quintile 1 (Q1) indicating the least deprivation; Q3, intermediate deprivation; and Q5, the most deprivation. Segmented linear regression was used to estimate monthly trends in outcomes before, at the start of, and in the first year of the COVID-19 pandemic. Results Of 173 915 patients in the study cohort (mean [SD] age, 72.1 [12.5] years; males, 54.1% [95% CI, 53.8%-54.3%]), 83.7% (95% CI, 83.6%-83.9%) died in the pre–COVID-19 period and 16.3% (95% CI, 16.1%-16.4%) died in the COVID-19 period, 54.5% (95% CI, 54.2%-54.7%) died at home during the entire study period, and 57.8% (95% CI, 57.5%-58.0%) received SPC at the end of life. In March 2020, home deaths increased by 8.3% (95% CI, 7.4%-9.1%); however, this increase was less marked in Q5 (6.1%; 95% CI, 4.4%-7.8%) than in Q1 (11.4%; 95% CI, 9.6%-13.2%) and Q3 (10.0%; 95% CI, 9.0%-11.1%). There was a simultaneous decrease of 5.3% (95% CI, −6.3% to –4.4%) in the rate of SPC at the end of life, with no significant difference among quintiles. Patients who received SPC at the end of life (vs no SPC) were more likely to die at home before and during the pandemic. However, there was a larger immediate increase in home deaths among those who received no SPC at the end of life vs those who received SPC (Q1, 17.5% [95% CI, 15.2%-19.8%] vs 7.6% [95% CI, 5.4%-9.7%]; Q3, 12.7% [95% CI, 10.8%-14.5%] vs 9.0% [95% CI, 7.2%-10.7%]). For Q5, the increase in home deaths was significant only for patients who did not receive SPC (13.9% [95% CI, 11.9%-15.8%] vs 1.2% [95% CI, −1.0% to 3.5%]). Conclusions and Relevance These findings suggest that the COVID-19 pandemic was associated with amplified socioeconomic disparities in death at home and SPC delivery at the end of life. Future research should focus on the mechanisms of these disparities and on developing interventions to ensure equitable and consistent SPC access.
Related Topics
Concepts
Medicine
Socioeconomic status
Pandemic
Palliative care
Cohort
Demography
Coronavirus disease 2019 (COVID-19)
Cohort study
End-of-life care
Gerontology
Environmental health
Population
Internal medicine
Disease
Nursing
Sociology
Infectious disease (medical specialty)
Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1001/jamanetworkopen.2024.0503
- https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2815471/iqbal_2024_oi_240041_1708128567.06036.pdf
- OA Status
- gold
- Cited By
- 8
- References
- 46
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4392190264
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
-
https://openalex.org/W4392190264Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1001/jamanetworkopen.2024.0503Digital Object Identifier
- Title
-
Socioeconomic Status, Palliative Care, and Death at Home Among Patients With Cancer Before and During COVID-19Work title
- Type
-
articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2024Year of publication
- Publication date
-
2024-02-27Full publication date if available
- Authors
-
Javaid Iqbal, Rahim Moineddin, Robert Fowler, Monika K. Krzyzanowska, Christopher M. Booth, James Downar, Jenny Lau, Lisa W. Le, Gary Rodin, Hsien Seow, Peter Tanuseputro, Craig C. Earle, Kieran L. Quinn, Breffni Hannon, Camilla ZimmermannList of authors in order
- Landing page
-
https://doi.org/10.1001/jamanetworkopen.2024.0503Publisher landing page
- PDF URL
-
https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2815471/iqbal_2024_oi_240041_1708128567.06036.pdfDirect link to full text PDF
- Open access
-
YesWhether a free full text is available
- OA status
-
goldOpen access status per OpenAlex
- OA URL
-
https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2815471/iqbal_2024_oi_240041_1708128567.06036.pdfDirect OA link when available
- Concepts
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Medicine, Socioeconomic status, Pandemic, Palliative care, Cohort, Demography, Coronavirus disease 2019 (COVID-19), Cohort study, End-of-life care, Gerontology, Environmental health, Population, Internal medicine, Disease, Nursing, Sociology, Infectious disease (medical specialty)Top concepts (fields/topics) attached by OpenAlex
- Cited by
-
8Total citation count in OpenAlex
- Citations by year (recent)
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2025: 6, 2024: 2Per-year citation counts (last 5 years)
- References (count)
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46Number of works referenced by this work
- Related works (count)
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10Other works algorithmically related by OpenAlex
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