The European Journal of Public Health Advance Access originally published online on October 26, 2006
The European Journal of Public Health 2007 17(3):285-290; doi:10.1093/eurpub/ckl243
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Infectious and allergic diseases, cancer, and diabetes |
A tale of two cities: Factors affecting place of cancer death in London and New York
Sandra L. Decker1,* and Irene J. Higginson2
1 National Center for Health Statistics and National Bureau of Economic Research, MD 20782 USA
2 Department of Palliative Care and Policy, King's College London and The Cicely Saunders Foundation London, UK
* This work was completed while Sandra Decker was a Senior Research Analyst at the International Longevity Center USA. The findings and conclusions in this paper are those of the authors and do not necessarily represent the views of the National Center for Health Statistics, or of the International Longevity Center—USA or any of its sponsors.
Correspondence: Sandra L. Decker, National Center for Health Statistics, 3311 Toledo Road, Hyattsville, MD 20782, USA, tel.: +1 301 458 4748, fax: +1 301 458 2688; e-mail: SDecker{at}cdc.gov
Received January 9, 2006 , accepted September 9, 2006
Background: Most American and English cancer patients prefer to die at home. Factors associated with greater likelihood of dying at home have been contradictory in many studies and no studies have compared the effects of factors in different countries. The objective of this paper is to compare the factors affecting place of cancer death in two major cities, New York and London. Methods: We use data on all individuals aged 
40 dying of cancer in London (59 604) and New York City (51 668) in the years 1995 through 1998. The probability of death at home is examined in each city as a function of gender, age group (40–55, 56–64, 65–74, 75+), year, type of cancer, and area socioeconomic status, using multiple logistic regression. Results: Although the probability of death at home is the same in the two cities (
1 in 5), being female lowers the odds of death at home by 7% in London, and raises it by 22% in New York. Older age is associated with increased odds of dying at home in New York but decreased odds of dying at home in London. Being in the lowest tercile of socioeconomic status (relative to the highest) lowers the odds of death at home by 22% in London and 39% in New York. Conclusion: Site of death varies significantly by patient and area characteristics in both cities, an understanding, which should be taken account of in future planning of end-of-life care.
Keywords: place of cancer death