Ethnic minority patients more likely to enter palliative care via specialist referral, national cohort study finds

A retrospective cohort study of 200,876 deceased patients in England, using anonymised primary care data, examined whether ethnicity affects primary-care palliative care identification and coding [Primary Study]. After adjustment for age, sex, frailty, deprivation and diagnosis, there was no statistically significant association between ethnicity and whether a patient received a primary-care palliative care record. However, patients from ethnic minority groups were significantly more likely than White patients to have their first palliative care record be a specialist, rather than primary-care, record. Adjusted survival from first record to death also differed by ethnicity: patients from Asian and from Black, African and Caribbean groups survived significantly longer than White groups, while patients from “Other” ethnic groups had significantly shorter survival.

This is a national, England-wide dataset with multilevel regression and Cox proportional-hazards adjustment, giving reasonably robust estimates — though, as an observational study of coded records, it cannot distinguish true underlying need from how consistently that need is recorded.

The authors’ own conclusion is that ensuring and monitoring equitable palliative care access requires continued improvement in identification practice and audits of data quality. For primary and specialist palliative services, the finding cautions against treating “no disparity in identification rates” as evidence that the pathway overall is equitable — route of entry and survival outcomes appear to vary by ethnicity even where headline identification rates do not, and warrant separate monitoring.