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The European Journal of Public Health Advance Access published online on October 26, 2006
The European Journal of Public Health, doi:10.1093/eurpub/ckl243
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© The Author 2006. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
Received January 9, 2006
Accepted September 9, 2006

Article

A tale of two cities: Factors affecting place of cancer death in London and New York

Sandra L. Decker 1 * * and Irene J. Higginson 2

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

* To whom correspondence should be addressed.
Sandra L. Decker, E-mail: SDecker{at}cdc.gov


  Abstract

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.
* 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.
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