Mortality among care home residents in England during the first and second waves of the COVID-19 pandemic: an observational study of 4.3 million adults over the age of 65

Schultze, A; Nightingale, E; Evans, D; Hulme, W; Rosello, A; Bates, C; Cockburn, J; MacKenna, B; Curtis, HJ; Morton, CE; Croker, R; Bacon, S; McDonald, HI; Rentsch, CT; Bhaskaran, K; Mathur, R; Tomlinson, LA; Williamson, EJ; Forbes, H; Tazare, J; Grint, D; Walker, AJ; Inglesby, P; DeVito, NJ; Mehrkar, A; Hickman, G; Davy, S; Ward, T; Fisher, L; Green, AC; Wing, K; Wong, AY; McManus, R; Parry, J; Hester, F; Harper, S; Evans, SJ; Douglas, IJ; Smeeth, L; Eggo, RM; Goldacre, B; Leon, DA

Journal article

Mortality among care home residents in England during the first and second waves of the COVID-19 pandemic: an observational study of 4.3 million adults over the age of 65

Abstract:: Background
Residents in care homes have been severely impacted by COVID-19. We describe trends in the mortality risk among residents of care homes compared to private homes.
Methods
On behalf of NHS England we used OpenSAFELY-TPP to calculate monthly age-standardised risks of death due to all causes and COVID-19 among adults aged >=65 years between 1/2/2019 and 31/03/2021. Care home residents were identified using linkage to Care and Quality Commission data.
Findings
We included 4,340,648 people aged 65 years or older on the 1st of February 2019, 2.2% of whom were classified as residing in a care or nursing home. Age-standardised mortality risks were approximately 10 times higher among care home residents compared to those in private housing in February 2019: comparative mortality figure (CMF) = 10.59 (95%CI = 9.51, 11.81) among women, and 10.87 (9.93, 11.90) among men. By April 2020 these relative differences had increased to more than 17 times with CMFs of 17.57 (16.43, 18.79) among women and 18.17 (17.22, 19.17) among men. CMFs did not increase during the second wave, despite a rise in the absolute age-standardised COVID-19 mortality risks.
Interpretation
COVID-19 has had a disproportionate impact on the mortality of care home residents in England compared to older residents of private homes, but only in the first wave. This may be explained by a degree of acquired immunity, improved protective measures or changes in the underlying frailty of the populations. The care home population should be prioritised for measures aimed at controlling COVID-19.
Funding
Medical Research Council MR/V015737/1

Publication status:: Published

Peer review status:: Peer reviewed

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APA Style

Schultze, A., Nightingale, E., Evans, D., Hulme, W., Rosello, A., Bates, C., Cockburn, J., MacKenna, B., Curtis, H. J., Morton, C. E., Croker, R., Bacon, S., McDonald, H. I., Rentsch, C. T., Bhaskaran, K., Mathur, R., Tomlinson, L. A., Williamson, E. J., Forbes, H., … Leon, D. A. (2022). Mortality among care home residents in England during the first and second waves of the COVID-19 pandemic: an observational study of 4.3 million adults over the age of 65. The Lancet Regional Health - Europe, 14(100295).

MLA Style

Schultze, A, et al. “Mortality among Care Home Residents in England during the First and Second Waves of the COVID-19 Pandemic: an Observational Study of 4.3 Million Adults over the Age of 65.” The Lancet Regional Health - Europe, vol. 14, no. 100295, 2022.

Chicago Style

Schultze, A, E Nightingale, D Evans, et al. 2022. “Mortality among Care Home Residents in England during the First and Second Waves of the COVID-19 Pandemic: an Observational Study of 4.3 Million Adults over the Age of 65.” The Lancet Regional Health - Europe 14 (100295).
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