Understanding ethnic disparities in opioid prescribing and acute healthcare use at the end of life: a mediation analysis of linked national cancer data
Background
People from minority ethnic communities with cancer often experience poorer care and worse outcomes towards the end of life. Previous national research found that people from minority ethnic groups were less likely to receive strong pain medicines (opioids) and more likely to attend emergency departments or be admitted to hospital during their final three months of life. While these inequalities have been identified, the reasons behind them remain unclear. Understanding the factors that contribute to these differences is essential for improving equity in palliative and end-of-life care.
Aims and Objectives
This study aims to understand the factors that contribute to ethnic inequalities in opioid prescribing and emergency healthcare use among people with cancer at the end of life.
The objectives are to:
- Investigate why people from minority ethnic communities are less likely to receive opioid pain medication and more likely to experience emergency department attendances and hospital admissions towards the end of life.
- Examine whether opioid prescribing, multiple long-term health conditions (multimorbidity) and socioeconomic deprivation help explain these differences.
- Identify the pathways through which inequalities arise using mediation analysis.
- Generate evidence to support future interventions, policy development and service improvements aimed at reducing inequalities in palliative and end-of-life care.
Methods
The project is a secondary analysis of linked, anonymised national healthcare datasets. Researchers will analyse healthcare records from more than 230,000 adults who died with cancer in England between 2011 and 2021.
The study will:
- Examine patterns of opioid prescribing across different ethnic groups.
- Investigate links between opioid prescribing, multimorbidity, socioeconomic deprivation and acute healthcare use.
- Use mediation analysis, a statistical method that helps identify how and why inequalities occur.
- Apply an intersectional approach, accounting for factors such as age, sex, deprivation, comorbidity, cancer type and geographical region.
Further Information
This project is led by Professor Jonathan Koffman, Professor of Palliative Care at the Wolfson Palliative Care Research Centre, Hull York Medical School.
The study is funded through NIHR Applied Research Collaboration Yorkshire & Humber Extension Funding and involves collaboration between the University of Hull, King’s College London, the University of Cambridge and NIHR ARC Yorkshire & Humber.
The project sits within the Health and Care in our Ageing Society theme and focuses on Care at the End of Life.
Findings are expected to be available during 2026 and will be shared through peer-reviewed publications, conference presentations, policy briefings, stakeholder workshops and public engagement activities.
The study will provide the first evidence on the mechanisms underlying ethnic inequalities in cancer pain management and emergency healthcare use at the end of life. The findings will help commissioners, clinicians and policymakers identify where improvements are needed to ensure more equitable access to high-quality palliative care and reduce avoidable hospital use.