TY - JOUR
T1 - Mortality of Care Home Residents and Community-Dwelling Controls During the COVID-19 Pandemic in 2020
T2 - Matched Cohort Study
AU - Gulliford, Martin C.
AU - Prevost, A. Toby
AU - Clegg, Andrew
AU - Rezel-Potts, Emma
N1 - Funding Information:
The authors were supported by the National Institute for Health Research Biomedical Research Centre at Guy's and St Thomas’ Hospitals and King's College London. The views expressed are those of the authors and not necessarily those of the National Health Service, the National Institute for Health Research, or the Department of Health. The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The authors had full access to all the data in the study and shared final responsibility for the decision to submit for publication.
Funding Information:
The authors were supported by the National Institute for Health Research Biomedical Research Centre at Guy’s and St Thomas’ Hospitals and King’s College London . The views expressed are those of the authors and not necessarily those of the National Health Service, the National Institute for Health Research, or the Department of Health. The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The authors had full access to all the data in the study and shared final responsibility for the decision to submit for publication.
Publisher Copyright:
© 2022 The Authors
PY - 2022/6
Y1 - 2022/6
N2 - Objective: This study aimed to estimate and compare mortality of care home residents, and matched community-dwelling controls, during the COVID-19 pandemic from primary care electronic health records in England. Design: Matched cohort study. Setting and Participants: Family practices in England in the Clinical Practice Research Datalink Aurum database. There were 83,627 care home residents in 2020, with 26,923 deaths; 80,730 (97%) were matched on age, sex, and family practice with 300,445 community-dwelling adults. Methods: All-cause mortality was evaluated and adjusted rate ratios by negative binomial regression were adjusted for age, sex, number of long-term conditions, frailty category, region, calendar month or week, and clustering by family practice. Results: Underlying mortality of care home residents was higher than community controls (adjusted rate ratio 5.59, 95% confidence interval 5.23‒5.99, P < .001). During April 2020, there was a net increase in mortality of care home residents over that of controls. The mortality rate of care home residents was 27.2 deaths per 1000 patients per week, compared with 2.31 per 1000 for controls. Excess deaths for care home residents, above that predicted from pre-pandemic years, peaked between April 13 and 19 (men, 27.7, 95% confidence interval 25.1‒30.3; women, 17.4, 15.9‒18.8 per 1000 per week). Compared with care home residents, long-term conditions and frailty were differentially associated with greater mortality in community-dwelling controls. Conclusions and Implications: Individual-patient data from primary care electronic health records may be used to estimate mortality in care home residents. Mortality is substantially higher than for community-dwelling comparators and showed a disproportionate increase in the first wave of the COVID-19 pandemic. Care home residents require particular protection during periods of high infectious disease transmission.
AB - Objective: This study aimed to estimate and compare mortality of care home residents, and matched community-dwelling controls, during the COVID-19 pandemic from primary care electronic health records in England. Design: Matched cohort study. Setting and Participants: Family practices in England in the Clinical Practice Research Datalink Aurum database. There were 83,627 care home residents in 2020, with 26,923 deaths; 80,730 (97%) were matched on age, sex, and family practice with 300,445 community-dwelling adults. Methods: All-cause mortality was evaluated and adjusted rate ratios by negative binomial regression were adjusted for age, sex, number of long-term conditions, frailty category, region, calendar month or week, and clustering by family practice. Results: Underlying mortality of care home residents was higher than community controls (adjusted rate ratio 5.59, 95% confidence interval 5.23‒5.99, P < .001). During April 2020, there was a net increase in mortality of care home residents over that of controls. The mortality rate of care home residents was 27.2 deaths per 1000 patients per week, compared with 2.31 per 1000 for controls. Excess deaths for care home residents, above that predicted from pre-pandemic years, peaked between April 13 and 19 (men, 27.7, 95% confidence interval 25.1‒30.3; women, 17.4, 15.9‒18.8 per 1000 per week). Compared with care home residents, long-term conditions and frailty were differentially associated with greater mortality in community-dwelling controls. Conclusions and Implications: Individual-patient data from primary care electronic health records may be used to estimate mortality in care home residents. Mortality is substantially higher than for community-dwelling comparators and showed a disproportionate increase in the first wave of the COVID-19 pandemic. Care home residents require particular protection during periods of high infectious disease transmission.
KW - care home
KW - COVID-19
KW - mortality
KW - nursing home
KW - pandemic
KW - primary care
KW - SARS-CoV-2
UR - http://www.scopus.com/inward/record.url?scp=85130326868&partnerID=8YFLogxK
U2 - 10.1016/j.jamda.2022.04.003
DO - 10.1016/j.jamda.2022.04.003
M3 - Article
C2 - 35561757
AN - SCOPUS:85130326868
SN - 1525-8610
VL - 23
SP - 923-929.e2
JO - Journal Of The American Medical Directors Association
JF - Journal Of The American Medical Directors Association
IS - 6
ER -
