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A high proportion of lifetime healthcare spending occurs in the last year of life, perhaps as much as one third.1 For the individual, the costs of coping with illness and accessing healthcare are also likely to be high, at a time when their earnings may have fallen because of sickness. Evidence is available for both downward social mobility after the onset of illness, and the impoverishment of bereaved partners.2,3 Changes in financial circumstances leading up to death have seldom been explored in health-related research, despite this being a crucial time for welfare interventions, many of which are either means-tested or attract fees. In this study, we investigated absolute and relative movement in income in the 3 years leading up to death in Sweden.
PARTICIPANTS, METHODS AND RESULTS
Data were analysed from the linked population registers in Stockholm County (population 1.8 million) for all deaths in 2002. Net household income after all taxes and transfers was equivalised using the Statistics Sweden scale and placed into one of 20 income bands for the whole population (equivalising income refers to the process of adjusting income to take into account the size and composition of the household). Each individual was then classified by how many income groups they had moved, from 1998 (3 years before death) to 2001 (the year before death). These were compared with …
Funding: BH was funded by the UK Medical Research Council through a Special Training Fellowship in Health of the Public Research, and BB was supported by the Swedish Council for Working Life and Social Research. The funders had no influence on the content or publication of findings
Competing interests: None.
Ethical permission for the study was granted by the regional ethics committee in Stockholm (ref 04-521/5). Statistics Sweden provided the data.
All authors contributed to study design and data interpretation. BH and AW analysed the data, BH wrote the first draft and all authors approved the final draft. BH and BB will act as guarantors.