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How many people will need palliative care in 2040? Past trends, future projections and implications for services

Etkind, S. N.; Bone, A. E.; Gomes, B.; Lovell, N.; Evans, C. J.; Higginson, I. J.; Murtagh, F. E. M.


S. N. Etkind

A. E. Bone

B. Gomes

N. Lovell

C. J. Evans

I. J. Higginson


Background: Current estimates suggest that approximately 75% of people approaching the end-of-life may benefit
from palliative care. The growing numbers of older people and increasing prevalence of chronic illness in many
countries mean that more people may benefit from palliative care in the future, but this has not been quantified.
The present study aims to estimate future population palliative care need in two high-income countries.
Methods: We used mortality statistics for England and Wales from 2006 to 2014. Building on previous diagnosis-based
approaches, we calculated age- and sex-specific proportions of deaths from defined chronic progressive illnesses to
estimate the prevalence of palliative care need in the population. We calculated annual change over the 9-year period.
Using explicit assumptions about change in disease prevalence over time, and official mortality forecasts, we
modelled palliative care need up to 2040. We also undertook separate projections for dementia, cancer and
organ failure.
Results: By 2040, annual deaths in England and Wales are projected to rise by 25.4% (from 501,424 in 2014 to 628,659).
If age- and sex-specific proportions with palliative care needs remain the same as in 2014, the number of people
requiring palliative care will grow by 25.0% (from 375,398 to 469,305 people/year). However, if the upward trend
observed from 2006 to 2014 continues, the increase will be of 42.4% (161,842 more people/year, total 537,240). In
addition, disease-specific projections show that dementia (increase from 59,199 to 219,409 deaths/year by 2040) and
cancer (increase from 143,638 to 208,636 deaths by 2040) will be the main drivers of increased need.
Conclusions: If recent mortality trends continue, 160,000 more people in England and Wales will need palliative care by
2040. Healthcare systems must now start to adapt to the age-related growth in deaths from chronic illness, by focusing
on integration and boosting of palliative care across health and social care disciplines. Countries with similar
demographic and disease changes will likely experience comparable rises in need.


Etkind, S. N., Bone, A. E., Gomes, B., Lovell, N., Evans, C. J., Higginson, I. J., & Murtagh, F. E. M. (2017). How many people will need palliative care in 2040? Past trends, future projections and implications for services. BMC medicine, 15(1),

Journal Article Type Article
Acceptance Date Apr 21, 2017
Online Publication Date May 18, 2017
Publication Date 2017-12
Deposit Date Nov 15, 2017
Publicly Available Date Nov 30, 2017
Journal BMC Medicine
Electronic ISSN 1741-7015
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 15
Issue 1
Keywords Mortality; Forecasting; Palliative care; Needs assessment; Health services needs and demand; Chronic disease; Comorbidity
Public URL
Publisher URL


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Copyright Statement
© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0<br /> International License (, which permits unrestricted use, distribution, and<br /> reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to<br /> the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver<br /> ( applies to the data made available in this article, unless otherwise stated.

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