Association of socioeconomic status (SES) with use of specialist palliative care (SPC) among people who died with cancer before and during the COVID-19 pandemic.
Bibliographic record
Abstract
e18504 Background: Access to high-quality care, including SPC, is known to vary according to SES. The effect of SES on access to SPC during the COVID-19 pandemic remains unknown. We measured the association of SES with SPC use in different care settings among people who died with cancer before and during the COVID-19 pandemic. Methods: This retrospective, population-based cohort study included 173,915 adult patients who died with cancer from 16/3/2015 to 15/3/2020 (pre-pandemic), and from 16/3/2020 to 15/3/2021 (pandemic period), in Ontario, Canada; March 16, 2020 coincided with the start of pandemic-related hospital entrance screening. The primary outcome was access to SPC in the last 30 days of life, measured as the percentage of people with at least one SPC visit and the rate of visits/patient/30 days across home, hospital inpatient, and outpatient care settings. We used an interrupted time series analysis with segmented linear regression accounting for serial correlation to examine the immediate and gradual changes due to the pandemic. Analyses were stratified by SES, defined using area-level material deprivation quintiles (Q1, least to Q5, most deprived). Results: In total, 100,462 (57.8%) people received SPC in the last 30 days of life. The access to SPC increased steadily by 0.13% per 30 days over the pre-pandemic period ( P<0.001), with a drop of 5.34% at the start of pandemic ( P<0.001) and a trend increase of 0.19% during the pandemic period ( P = 0.10). The table shows study outcomes by care setting and SES. At baseline, patients in Q5 (vs Q1) had lower rates of SPC home visits, while rates of inpatient visits and outpatient visits were similar. Pre-pandemic for Q1 and Q5, inpatient visits were decreasing, outpatient visits were increasing, and home visits were stable. For both Q1 and Q5, there was an immediate decrease in home visits and increase in outpatient visits at pandemic onset, followed by a recovery in home visits; trends for inpatient and outpatient visits were unchanged. Conclusions: The COVID-19 pandemic led to an immediate decrease in access to SPC among people who died with cancer, particularly for home visits. SES was significantly associated with access to home visits, both before and during the pandemic. [Table: see text]
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".