Does ethnicity affect primary palliative care identification and coding? Retrospective cohort study

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 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: Retrospective cohort study of deceased patients in England utilising anonymised primary care data. METHOD: Multilevel logistic regression examined associations between ethnicity and primary palliative care records. Cox regression assessed time from first record to death. Chi-squared tests examined differences between first palliative care codes. RESULTS: 200,876 patients included: 32.3% (n=64,887) had a primary palliative care record. Multilevel logistic regression (n=64,887) showed no statistically significant association between ethnicity and identification after adjustment for age, gender, frailty, deprivation and diagnosis. After adjustment, a mixed-effects Cox proportional hazards model (n=58,681) indicated; compared with patients from White groups, patients from Asian (HR=0.94, 95%CI=0.89-1.00, p=0.040) and Black, African, Caribbean groups (HR=0.93, 95%CI=0.86-0.99, p=0.03) survived significantly longer, and patients from 'Other' groups had significantly shorter survival (HR=1.14, 95%CI=1.05-1.23, p=0.002). Patients from ethnic minorities were significantly (p<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.