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Does culture affect the location of death among cancer patients in British Columbia? : a pilot study utilizing standard and novel statistical methods in end-of-life research Regier, Michael David

Abstract

Objective Understanding the clinical, cultural, social, demographic and economic landscape that affects end-of-life health service utilization for British Columbian cancer patients is novel work. The location of death was taken as the initial use of health services to investigate. The goals for this thesis are to understand the trends in the place of death from 1997 to 2003 for adult British Columbians that died of cancer, understand which predictive factors of dying out of hospital, develop new indicators of culture, and evaluate the utility of data mining for end-of-life research. Methods The subjects were all adults, age 18 years and older who died of cancer, in British Columbia as identified from the death certificates, from 1997 to 2003. Data from the British Columbia Cancer Registry and the British Columbian Vital Statistics were linked. To this the Postal Code Conversion File program was used to associate each subject with a dissemination area. This was used to impute ecological measures of income, ethnicity, language and religion to each patient. The culture indicators were based upon an indicator developed using principal component analysis and k-means. When considering the utility of linear discriminant analysis, logistic regression, neural networks, classification trees, and nearest neighbours for end-of-life research, a sub set comprised of all adults aged 20 years and older from 1999-2003 was obtained from the previously described data set. Receiver Operating Characteristic Curve, Area Under the Curve (AUC), Misclassification Curve and Hit curve and cross-validation were used. Conclusions After all other significant factors have been taken into consideration; people who were' more likely to die out of hospital were females, lived in neighbourhoods in a higher income quintile, lived in either the Interior or Northern Health Authorities, lived in communities with less than 500,000 people, died from breast, colorectal, pancreatic or prostate cancer, had longer survival times, and were older. It was found that people associated with the derived the Aboriginal Presence, British Isles Presence and the Americas and Europe ethnic origins cluster and those people associated with the Chinese .Presence and the Punjabi Presence mother tongue cluster were less likely to die out of hospital.

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