{
  "abstract": "Background: Europe is experiencing population ageing with increasing “slow dying” and serious health-related suffering becoming a major public health challenge. Despite being a recognised right, palliative care (PC) remains unevenly implemented. This study examines factors influencing PC access across micro-, meso-, and macro-levels, assessing whether inequalities persist beyond clinical need.\n\nMethods: Data from SHARE (Waves 7–9) were analysed, including decedents with a completed end-of-life proxy interview and a cause of death consistent with PC needs. The outcome was self-reported PC access in the last month of life. Given the hierarchical structure (individuals nested within 27 EU countries), multilevel logistic regression models were estimated. We fitted a null model, a micro/meso-level model assessing compositional effects (including age, sex, education, income, household size, cause of death, symptom burden, and area of residence), and a full model adding a macro-level predictor (welfare regime).\n\nResults: A total of 5,320 individuals were included. The null model attributed 9.4% of the variance to country-level differences, which did not decrease after adjustment for individual determinants (ICC = 0.11), but declined to 0.06 after including welfare regimes. Compared with Nordic systems, Eastern regimes showed lower access (OR 0.39, 95% CI 0.21–0.74).Symptom burden was the strongest predictor (OR 3.52, 2.74–4.52), and diagnosis-based disparities persisted, (organ failure vs cancer: OR 0.27, 0.23–0.31). Socioeconomic factors were not significant, whereas rural residence was associated with lower access (OR 0.78, 0.61–0.99).\n\nConclusions: Inequalities in European end-of-life care appear to be driven less by socioeconomic status than by geopolitical context, geography, and diagnostic labelling. Addressing these gaps requires shifting to needs-based eligibility and strengthening community-based services to support non-cancer trajectories and mitigate geographic barriers\n\nKey messages: • Palliative care access in Europe is shaped more by welfare systems, geography and diagnosis than by socioeconomic status, highlighting structural inequalities in end-of-life care.\n\n• Non-cancer and rural patients face lower access to palliative care, supporting a shift toward needs-based eligibility and stronger community services.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": "abstract",
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "name": "A Bellini"
    },
    {
      "name": "P Grassi"
    },
    {
      "name": "C Seghieri"
    },
    {
      "name": "D Vignoli"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/cqw4p5c57sya3.bib",
  "cited_by": 0,
  "doi": "10.1093/eurpub/ckag169.128",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13697784/",
  "id": "cqw4p5c57sya3",
  "issns": [
    "1101-1262",
    "1464-360X"
  ],
  "landing_url": "https://doi.org/10.1093/eurpub/ckag169.128",
  "language": "en",
  "licence": "CC-BY-NC-4.0",
  "licence_label": "CC BY-NC 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "3. PARALLEL PROGRAMME"
    ],
    [
      "heading",
      "AcademicSubjects/MED00860"
    ],
    [
      "heading",
      "AcademicSubjects/SOC01210"
    ],
    [
      "heading",
      "AcademicSubjects/SOC02610"
    ],
    [
      "heading",
      "C.3. Oral presentations: Social determinants and access to care"
    ],
    [
      "openalex",
      "2739|Palliative Care and End-of-Life Issues"
    ]
  ],
  "openalex": "W7223708818",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13697784/pdf/?tool=EBI",
  "pmcid": "PMC13697784",
  "pmid": null,
  "published": "2026-10-01",
  "publisher": "Oxford University Press",
  "ris": "https://research.draconitic.com/paper/cqw4p5c57sya3.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:18:47Z",
      "native_id": "PMC13697784",
      "source": "pmc",
      "url": "https://doi.org/10.1093/eurpub/ckag169.128"
    },
    {
      "first_seen": "2026-10-30T12:21:45Z",
      "native_id": "PMC:PMC13697784",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13697784"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2739|Palliative Care and End-of-Life Issues",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Multilevel determinants of palliative care access in 27 European countries",
  "title_text": "Multilevel determinants of palliative care access in 27 European countries",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:34:46Z",
  "url": "https://research.draconitic.com/paper/cqw4p5c57sya3",
  "venue": "The European Journal of Public Health",
  "versions": []
}