Where Are We Dying? Ethnic Differences in Place of Death Among New Zealanders Dying of Cancer

Abstract

PURPOSE Around a third of people with cancer will die outside of their preferred place of death, with substantial variation occurring between and within countries in terms of place of death. Here, we examine place of death within the New Zealand cancer context, with specific focus on differences between Indigenous Māori and other ethnic groups. METHODS Using national-level data, we identified all those who died in New Zealand between 2007 and 2018 of cancer (N = 107,373), stratified by ethnicity and cancer type, and linked these patients to national health and mortality records. We then described the crude and age-standardized proportions of cancer deaths by location separately by ethnic group, and conducted logistic regression to compare odds of death within a given location between ethnic groups. RESULTS After adjusting for age, sex, and deprivation, we found that Māori people with cancer are more likely to die in a private residence than Europeans (46% v 26%; odds ratio [OR] 2.45; 95% CI, 2.36 to 2.55), and also somewhat more likely to die in hospital (27% v 23%; OR 1.26; 95% CI, 1.21 to 1.32). Commensurately, Māori are less likely to die in either hospice inpatient unit (14% v 27%; OR 0.48; 95% CI, 0.45 to 0.51) or residential care (12% v 30%; OR 0.56; 95% CI, 0.52 to 0.59). Pacific patients generally follow the same pattern as Māori patients. These findings were largely repeated across cancer types, with some variation in the magnitude not overall pattern. CONCLUSION It remains unclear whether these differences reflect differences in preferences for place of death between ethnic groups, or whether they reflect differences in access to appropriate supportive care. Further research is required to examine these differences in greater detail.

The epidemiology of dying within 48 hours of presentation to emergency departments: a retrospective cohort study of older people across Australia and New Zealand

“…Older people who were Aboriginal and/or Torres Strait Islander were also less likely to die in ED in our study. Other studies have found a greater likelihood to die in a private residence for Māori people [ 50 ] and a preference to die ‘on country’, surrounded by family and friends for Aboriginal and/or Torres Strait Islander people [ 51 ]. Our finding suggests that these preferences may have been translated somewhat into the care received in this cohort’s EDs.…”

Researching minoritised communities in palliative care: An agenda for change

“…Comparing – Most research into ethnicity and palliative care that has taken place in the USA, the UK, Australia and New Zealand is based largely on the comparative architecture and present data that invariably use the ‘white’ population, albeit unintentionally, as the standard. 31,32,53,82,109–115 This racial and ethnic nomenclature has the potential to lead to the phenomena of ethnocentricity or an inherent predisposition to view a single and often the majority culture as the standard against which others are or should be judged. 116 This has consequences for many aspects of palliative care research where ethnicity is a focus.…”