Adjusting for missing information in multilevel models with a non-binary response: identifying socioeconomic, cultural, demographic and clinical predictors of end-of-life health care service …

Many Canadians believe that equal access to health care is a fundamental right; however, evidence suggests that people experience unequal access to end-of-life care. For example, approximately 70 per cent of cancer patients die in hospital. Although little is known about Canadian preferences, international studies suggest people prefer to die at their home. Socioeconomic status is known to play a role in explaining health inequities. Michael Regier is examining whether the impact of the Canadian cultural mosaic (ethnic groups, languages and cultures that interact within Canadian society) on the use of health services is more complex than socioeconomic status alone. Each culture has its own expectations for health services, so the health system must be flexible enough to integrate various cultural understandings of health, but uniform enough to reach everyone. Regier is studying how additional “ecosocial” factors like ethnicity, language, family structure, religious beliefs and acculturation contribute to the way individuals and communities understand and use health care. He is investigating the place of death for cancer patients in BC from this perspective to determine differences in health determinants for end-of-life care. Health planners can use this information to improve access to end-of-life care across cultures, geographic areas and socioeconomic differences.