Characteristics of samples
Thirty-eight per cent (152) of the Ethnibus sample were Indian, 29% (117) were Pakistani, 22% (86) were Black Caribbean and 11% (45) were Chinese. Most (94% (555)) of the ONS Omnibus sample were white British, 2% (12) were white other, and three people were Indian Asian. Just over half of each sample were women (52% (207) of Ethnibus and 55% (324) of ONS Omnibus respondents). Reflecting the younger demography of ethnic minority groups in Britain, 91% (363) of the Ethnibus sample were aged 65<75, compared with 55% (326) of the ONS Omnibus sample; the remainder were aged 75+. More Ethnibus respondents were married/cohabiting than widowed (58% (230) vs 49% (285) of the ONS respondents). Fewer Ethnibus respondents than ONS respondents were owner occupiers (52% (208) vs 73% (429)). Almost a third (30% (118)) of Ethnibus respondents lived in households with four or more people aged 18+, compared with 1% (5%) of ONS respondents; and just 5% (19) of Ethnibus respondents lived alone, compared with about half of the ONS sample (48%, 286). The Ethnibus sample also had larger family networks: 64% (256) had four or more relatives who would help them practically, compared with about a third of ONS respondents (35% (176) and 34% (89), respectively). All differences reported above were significant using the χ2 test, at least at the 0.01 level.
Attitudes to death and dying
Significantly more of the ethnically diverse Ethnibus sample (55% (220)) than of the ONS British population sample (13% (73)) had the worst QoL death and dying sub-scale scores. In addition, more Ethnibus than ONS respondents expressed one to four extreme fears about death (77% (310) vs 41% (229)) (). These differences between samples were not explained by Ethnibus respondents being more likely to be younger.
Attitudes to death and dying by sample
Chinese people expressed the lowest levels of fear, although caution in interpretation is needed because of their smaller base numbers ().
WHOQOL-OLD death and dying sub-scale: summary by ethnic group (Ethnibus sample)
Better QoL was associated with reduced fear of dying in each sample. For the four death and dying items (item 6, concern about the way of dying; item 7, fear about not being able to control one's death; item 8, scared of dying; and item 9, fear of being in pain before death), the respective Spearman rank correlations with the OPQOL were: 0.135, 0.396, 0.310 and 0.020 (not significant with item 9: pain) for Ethnibus and 0.129, 0.120, 0.130 and 0.111 (all p<0.01) for ONS Omnibus. Age was significantly associated with each death and dying item for the ONS, but not the Ethnibus sample; the ONS correlations (rho) with age were: 0.158, 0.158, 0.162 and 0.164 for items 6–9, respectively, in the ONS sample (all p<0.01): older age reduced fear of dying. Age differences between the samples did not explain differences in fears about dying.
In the Ethnibus sample only, having more relatives who would help with practical tasks if needed increased fear of dying and its processes on three of the four items: Spearman rho for items 6, 7 and 8, respectively, were: −0.128 (p<0.05), −0.134 (p<0.01), −0.136 (p<0.01) and −0.072 (not significant with item on pain). Number of people to turn to in a personal crisis showed similar patterns, again in the Ethnibus sample only. Poorer self-rated health status, having a longstanding illness, and difficulties walking 400 yards were all associated with increased fear of dying per se (item 8), in the Ethnibus sample only: Spearman rho, −0.113 for self-rated health, −0.098 for longstanding illness, and −0.123 for ability to walk 400 yards (all p<0.05).
In the Ethnibus sample, there was a significant inverse correlation between being in the Indian ethnic group and greater fear of not being able to control one's death (Spearman rho, −0.102, p<0.05). Chinese people were significantly less likely to express fears about dying than the other ethnic groups, on three of the four items: Spearman rho for items 6–8, respectively, −0.066 (p<0.01), −0.208, −0.166 (p<0.01), and 0.021 (not significant) for item 9 (pain).
Logistic regression was used to examine independent predictors of extreme fears of dying (dependent variable). Variables that correlated significantly with two or more of the death and dying items, or the sub-scale, were selected for entry as the independent variables: OPQOL score; number of relatives who would provide practical help when needed; number of people who they could turn to in a crisis; number of different social activities engaged in during the past month; adjusted for chronic illness (reported longstanding illness, disability, infirmity 1, none 0), age (continuous) and sex (male 1, female 0). Ethnicity was also entered; a dummy variable was created for each ethnic group in the Ethnibus sample (specific group=1, rest=0). Ethnicity in the ONS Omnibus sample was dichotomised, as a few were in ethnic minority groups (white British 1, rest=0). In initial modelling, socioeconomic status was included to adjust for its effects. Religion was asked about in the Ethnibus survey only, and initial modelling also adjusted for religion in that sample. They made no significant contribution to the modelling and were removed in the final models.
In the final models, respondents in both samples with better, compared with worse, QoL (OPQOL scores) had significantly reduced odds of having extreme fears of dying (ethnically diverse sample, OR 0.924; 95% CI 0.898 to 0.951; British population sample, OR 0.981; 95% CI 0.966 to 0.996; both p<0.001). In the latter sample only, older age was protective (OR 0.957; 95% CI 0.930 to 0.985; p<0.001), while in the Ethnibus sample, having a longstanding illness (OR 2.024; 95% CI 1.158 to 3.535; p<0.05) and having more relatives to help them (OR 1.134; 95% CI 1.010 to 1.274; p<0.05) increased fears about dying ().
Logistic regression showing independent associations (OR, 95% CI with predictors on extreme fear of dying, adjusted by age, sex and ethnic status†)
Ethnicity was not significant, although the ORs reflected the patterns reported in the correlation analyses. In particular, Pakistani people had over twice the odds of having extreme fears about death and dying, although the CIs were wide, and Chinese people had reduced fears (see for details).