New evidence highlights ethnic inequalities in place of death in England and Wales

This research used data made available via the Office for National Statistics (ONS) Secure Research Service, which is being expanded and improved with ADR UK funding.

Author: Stephen Jivraj

Date: March 2026

Research summary

This study explored how place of death differs between ethnic groups in England and Wales, using high‑quality self‑reported ethnicity data from the ONS Census Longitudinal Study. It found that people from several minority ethnic backgrounds were more likely to die in hospital than White British people. It provides the first robust evidence of ethnic inequality in place of death in England and Wales. It has high potential for use by health service planners, integrated care systems, and providers of palliative, guiding targeted commissioning and monitoring of equity in access to palliative care.

For some groups, the difference could be explained by factors such as age, where they lived, levels of deprivation, and cause of death. However, for Bangladeshi men, Pakistani men, Indian men and women, and people recorded in the Other ethnic group, the higher likelihood of dying in hospital persisted even after taking these factors into account.

The research was supported by funding from Marie Curie and conducted through the ONS Secure Research Service, with further support provided to individual investigators through charitable and research funders.

Data used

The analysis used the Office for National Statistics Longitudinal Study. This links a 1% sample of the population in England and Wales to mortality records. The cohort included people who died between 1 January 2011 and 31 December 2017. Ethnicity was self‑reported at census and coded to eleven categories. The outcome was death in hospital versus death at home, hospice, or care home.

Office for National Statistics, released October 2025, ONS SRS Metadata Catalogue, dataset, Office for National Statistics Longitudinal Study (England and Wales): census‑to‑life events linkages – edition. https://doi.org/10.57906/z9xn-ng05

Additional data sources used:

• Area‑based deprivation: Index of Multiple Deprivation 2015.
• Urban–rural classification for England and Wales.
• Underlying cause of death from mortality records.

Methods used

The study used a cross‑sectional analysis of decedents in the Longitudinal Study. The main exposure was ethnicity. The outcome was death in hospital compared with home, hospice, or care home. The team ran Poisson models with robust standard errors. Models were run separately for men and women. Models were adjusted in steps for age, geography, socio‑economic factors, and underlying cause of death.

 The final sample was 34,230 decedents after excluding people who died in other locations and records with missing place of death.

Research findings

The study analysed 34,230 deaths between 2011 and 2017. Although hospital was the most common place of death overall, the likelihood of dying in hospital varied considerably between ethnic groups.

The analysis showed that some of the observed variation could be attributed to where people lived and their levels of deprivation—factors known to influence end‑of‑life care access. After adjusting for these, gaps narrowed for certain ethnic groups, indicating that geographic and socioeconomic differences played an important role for them.

However, for Bangladeshi men, Pakistani men, Indian men and women, and people categorised in the Other ethnic group, higher hospital death rates persisted even after all measured factors were included. This indicates that the differences observed for these groups reflect influences beyond those captured in available data.

These persisting inequalities suggest the potential role of additional factors—such as cultural preferences, unmet palliative care needs, availability of informal care, or barriers to accessing community‑based end‑of‑life services—none of which were captured in the dataset.

Using high‑quality self‑reported ethnicity strengthened the reliability of the findings. The study’s large sample size also enabled analyses by gender within each ethnic group, identifying patterns that would have been obscured in more aggregated categories.

Research impact

The study provides the first robust evidence of ethnic inequality in place of death in England and Wales. It identifies specific groups with higher proportions of hospital death after accounting for other measured factors. Most people prefer to avoid hospital towards the end of life. This study can inform planning of palliative and end‑of‑life care by highlighting groups who may be more likely to die in hospital. It supports efforts to expand culturally appropriate community services and to reduce unplanned hospital use at the end of life.

The work highlights the value of self‑reported ethnicity in linked administrative data. It supports ongoing improvements in ethnicity data quality in health records. It also demonstrates the role of trusted research environments in understanding and addressing complex intersectional inequalities.

The findings are relevant to health service planners, integrated care systems, and providers of palliative care. They align with wider evidence of higher unplanned hospital use at end of life for some South Asian communities. The results can guide targeted commissioning and monitoring of equity in access to palliative care.

Research outputs

Publications and reports

• Journal article, Volume 40, Issue 2: Ethnic inequality in place of death: Analysis using ‘gold standard’ self‑reported ethnicity data from the Census Longitudinal Study. https://doi.org/10.1177/02692163251395455

About the ONS Secure Research Service

The ONS Secure Research Service is an accredited trusted research environment that provides secure access to de‑identified, unpublished data. It operates under the Five Safes Framework to ensure safe people, safe projects, safe settings, safe data, and safe outputs.

If you use ONS Secure Research Service data and would like to discuss writing a future case study, please get in touch at SRS.Impact@ons.gov.uk. Please also report any outputs here: Outputs Reporting Form.

Annex A: Project outputs in scope

• Analysis code: Stata SE 17 code repository – https://github.com/joannamariedavies/ONS_LS