Disparities in end-of-life care and place of death in people with malignant brain tumors – a Swedish registry study

Abstract

Abstract Background Malignant brain tumors often lead to death. While improving future treatments is essential, end-of-life care must also be addressed. To ensure equitable palliative care, understanding place of death is crucial, as disparities may lead to inequity of care. This study aims to identify place of death in adults with malignant brain tumors in Sweden, and the potential associations with official palliative care status by the ICD-10 code Z-51.5, sociodemographic factors, health service characteristics, and healthcare service utilization. Methods A population-level registry study examined the place of death among adults who died of malignant brain tumors in Sweden from 2013-2019. Descriptive statistics, univariable and multivariable binary logistic regression analyses were performed. Results We identified 3 888 adults who died from malignant brain tumors. Of these, 64.4% did not receive an official palliative care status. Specialized palliative care was not utilized in 57.2% at the place of death, and in 80.0% of nursing home deaths. In the last month of life, 53.5% of hospital deaths involved one transfer, while 41.8% had two or more transfers. The odds ratio of dying in hospital versus at home was higher, with two or more transfers (OR 0.63(0.40,0.99)). The odds ratio of dying in hospital versus at home showed significant regional differences. Conclusions Despite the severity of their diagnosis, only a minority of patients utilized specialized palliative services at death, and this varied by the place of death. Significant regional disparities were found between hospital and home deaths, indicating unequal end-of-life palliative care in this patient group.