Background It has been estimated that someone with a terminal illness in the UK can experience a negative financial impact of up to £16,000 per year (APPG for Terminal Illness, 2019). However, while poverty at the end of life is recognised as a legitimate concern, its magnitude has remained unclear. This research aimed to produce a statistical profile to increase understanding of the risk and prevalence of poverty in the last year of life for people across the UK.
Methods The analysis was based on data for individuals aged 20 and older from of the UK Household Longitudinal Study, Understanding Society. Mixed-effects binary logistic regression was used to estimate the probability of an individual being in poverty in a given year, based on their age, whether they were in the last 12 months of life, and the interaction between these variables. The estimates were used to produce a risk ratio that could be applied to population-level data on poverty rates and mortality rates. This was repeated for selected subgroups of the population based on geographical location, sex, ethnicity and diagnosis.
Results The regression analysis revealed a statistically significant, positive association between being at the end of life and being in poverty (OR=1.6. p<0.001). There was a significant interaction with age (p=0.08), with a stronger association between poverty and mortality for younger respondents.
When combined with population-level data, the estimates suggested that in 2019, more than 90,000 people died in poverty in the UK. Among working age people, the risk of experiencing poverty was 34% higher for those in the last 12 months of life than for others in the same age group, while for pensioners it was 23% higher. Elevated risks of poverty at the end of life were also observed among women, people from minority ethnic groups, and those with non-cancer diagnoses prior to death.
Discussion The findings show that poverty at the end of life is an extensive and wide-reaching issue that affects many people at a time when they are vulnerable and least able to deal with financial or material hardship. In policy terms, the findings draw attention to the importance of ensuring that people are able to access all of the support from the social security system to which they are entitled at the end of life, especially if faced with an unpredictable prognosis and a potentially long period of financial hardship.
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