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Socioeconomic inequality in drug reimbursement during end-of-life care: a nationwide study
  1. Cecilie Daugaard1,
  2. Mette Asbjoern Neergaard2,
  3. Anne Høy Seeman Vestergaard1,
  4. Mette Kjærgaard Nielsen3,
  5. Søren Paaske Johnsen1,4
  1. 1 Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
  2. 2 Palliative Care Team, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
  3. 3 Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
  4. 4 Department of Clinical Medicine, Danish Center for Clinical Health Services Research, Aalborg University, Aalborg, Denmark
  1. Correspondence to Cecilie Daugaard, Department of Clinical Epidemiology, Aarhus University Hospital, DK-8200 Aarhus, Denmark; cecilie.daugaard{at}


Background In Denmark, patients who are terminally ill have the right to drug reimbursement due to terminal illness (DRTI). DRTI, a proxy marker of planned end-of-life care, is intended to be equally accessible regardless of socioeconomic position. This study examined social and socioeconomic differences in DRTI among Danish patients who are terminally ill.

Methods This cross-sectional study based on individual-level nationwide data included all patients dying from cancer, dementia, ischaemic heart disease, chronic obstructive pulmonary disease, chronic liver disease, congestive heart failure, diabetes or stroke in 2006–2015 (n=307 188). We analysed associations between social and socioeconomic position (education, income, cohabiting status, migrant status and employment) and DRTI. Prevalence ratios (PR) and 95% CIs were estimated using log-linear models adjusted for age, gender, comorbidity, cause of death and residence.

Results Overall, 27.9% of patients received DRTI (n=85 616). A substantial difference in likelihood of receiving DRTI was observed among patients with a social and socioeconomic profile associated with the highest versus lowest probability of DRTI (adjusted PR 1.44, 95% CI 1.18 to 1.75). The probability of DRTI was higher among patients with high income compared with low income (adjusted PR 1.22, 95% CI 1.17 to 1.26). Also, living with a partner and being immigrant or descendant of such were associated with higher probability of DRTI compared with living alone and of Danish origin, whereas employment was associated with lower probability of DRTI compared with retirement.

Conclusion Social and socioeconomic position was associated with the likelihood of receiving DRTI, which indicates that planned end-of-life care is not equally accessible in Denmark.

  • access to healthcare
  • epidemiology
  • palliative care
  • socioeconomic
  • social inequalities

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  • Contributors CD was the study coordinator and was involved in designing the study and conducting a study protocol. CD made the statistical analyses, interpretation of data and wrote the manuscript. MAN, AHSV, MKN and SPJ contributed to the study design, study protocol, interpretation of data, and methodological and clinical review of manuscript. All authors approved the final version to be published.

  • Funding This study was funded by the Danish Cancer Society (R165-A10480-16-S7), Københavns Universitets Fond for Medicinstuderende, Fonden af 1870 and Helga og Peter Kornings Fond.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The study was approved by the Danish Data Protection Agency (Central Denmark Region: record number 1-16-02-407-14). According to Danish law, registry-based studies do not require ethical approval.

  • Provenance and peer review Not commissioned; externally peer reviewed.