| Summary: | 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. === Science, Faculty of === Statistics, Department of === Graduate
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