Trajectories of health and social care expenditure in the last year of life among people 70 years and older in Region Stockholm: a population-based cohort study

BACKGROUND: Death is increasingly postponed to older ages which has implications for future care planning as health and social care expenditure peaks during the end-of-life. Hence, a detailed understanding of the care services involved is needed. This study aims to identify patterns of health-and-social care expenditure among people 70 years and older in their last year of life and to examine the associated socio-demographic factors. METHODS: A population-based cohort study using linked register data, including those 70 years and older who died in Stockholm County in 2019 (N = 12,104). Health-and-social care expenditure was measured for the 365-days prior to date of death. A group-based trajectory model was used to identify common expenditure trajectories; the composition of care services and socio-demographic characteristics of the identified trajectories were assessed. RESULTS: Six expenditure trajectories were identified that varied widely in the care services consumed before death. Most decedents followed a "persistently high" trajectory (36.5%) and had the highest average expenditure on health (in-and-outpatient) and home-help. The second largest trajectory (26.3%) was characterized as "early rise, persistently high", who had the highest average expenditure on care home placements (SEK 532.0 K). Those in the lowest care expenditure trajectory were predominantly females in the lowest income quintile and born outside of Sweden. CONCLUSION: This study observed distinct trajectories of care expenditure among older people at the end-of-life and multiple factors contributed to these patterns. Most followed a trajectory where both where health and social expenditure remained high and persons relied on care in their own homes. These findings provide insight into the care resources used during the last year of life and may serve to inform future policies on care planning in the context of an ageing population.