Severe COVID-19 in people 55 and older during the first year of the pandemic in Sweden

Annika Rosengren; Christina E. Lundberg; Mia Söderberg; Ailiana Santosa; Jon Edqvist; Martin Lindgren; Maria Åberg; Magnus Gisslén; Josefina Robertson; Ottmar Cronie; Naveed Sattar; Jesper Lagergren; Maria Brandén; Jonas Björk; Martin Adiels

doi:10.1111/joim.13522

Severe COVID-19 in people 55 and older during the first year of the pandemic in Sweden

Annika Rosengren^*, Christina E. Lundberg, Mia Söderberg, Ailiana Santosa, Jon Edqvist, Martin Lindgren, Maria Åberg, Magnus Gisslén, Josefina Robertson, Ottmar Cronie, Naveed Sattar, Jesper Lagergren, Maria Brandén, Jonas Björk, Martin Adiels

^*Corresponding author for this work

Comprehensive Cancer Centre

Research output: Contribution to journal › Article › peer-review

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Abstract

Background: Exposure to many contacts is the main risk factor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, while risk of serious disease and death is chiefly determined by old age and comorbidities. Relative and population-attributable fractions (PAFs) of multiple medical and social exposures for COVID-19 outcomes have not been evaluated among older adults. Objectives: We describe the effect of multiple exposures on the odds of testing positive for the virus and of severe disease (hospital care or death) and PAFs in Swedish citizens aged 55 years and above. Methods: We used national registers to follow all citizens aged 55 years and above with respect to (1) testing positive, (2) hospitalization, and (3) death between 31 January 2020 and 1 February 2021. Results: Of 3,410,241 persons, 156,017 (4.6%, mean age 68.3 years) tested positive for SARS-CoV-2, while 35,999 (1.1%, mean age 76.7 years) were hospitalized or died (12,384 deaths, 0.4%, mean age 84.0 years). Among the total cohort, the proportion living without home care or long-term care was 98.8% among persons aged 55–64 and 22.1% of those aged 95 and above. After multiple adjustment, home care and long-term care were associated with odds ratios of 7.9 (95% confidence interval [CI] 6.8–9.1) and 22.5 (95% CI 19.6–25.7) for mortality, with PAFs of 21.9% (95% CI 20.9–22.9) and 33.3% (95% CI 32.4–34.3), respectively. Conclusion: Among Swedish residents aged 55 years and above, those with home care or long-term care had markedly increased risk for COVID-19 death during the first year of the pandemic, with over 50% of deaths attributable to these factors.

Original language	English
Pages (from-to)	641-653
Number of pages	13
Journal	Journal of Internal Medicine
Volume	292
Issue number	4
Early online date	3 Jun 2022
DOIs	https://doi.org/10.1111/joim.13522
Publication status	Published - Oct 2022

Keywords

comorbidity
COVID-19
demographics
mortality
population study
severe illness

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1111/joim.13522Licence: CC BY-NC

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Rosengren, A., Lundberg, C. E., Söderberg, M., Santosa, A., Edqvist, J., Lindgren, M., Åberg, M., Gisslén, M., Robertson, J., Cronie, O., Sattar, N., Lagergren, J., Brandén, M., Björk, J., & Adiels, M. (2022). Severe COVID-19 in people 55 and older during the first year of the pandemic in Sweden. Journal of Internal Medicine, 292(4), 641-653. https://doi.org/10.1111/joim.13522

@article{88c1259ce4bd43caa8a77794d1cda357,

title = "Severe COVID-19 in people 55 and older during the first year of the pandemic in Sweden",

abstract = "Background: Exposure to many contacts is the main risk factor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, while risk of serious disease and death is chiefly determined by old age and comorbidities. Relative and population-attributable fractions (PAFs) of multiple medical and social exposures for COVID-19 outcomes have not been evaluated among older adults. Objectives: We describe the effect of multiple exposures on the odds of testing positive for the virus and of severe disease (hospital care or death) and PAFs in Swedish citizens aged 55 years and above. Methods: We used national registers to follow all citizens aged 55 years and above with respect to (1) testing positive, (2) hospitalization, and (3) death between 31 January 2020 and 1 February 2021. Results: Of 3,410,241 persons, 156,017 (4.6%, mean age 68.3 years) tested positive for SARS-CoV-2, while 35,999 (1.1%, mean age 76.7 years) were hospitalized or died (12,384 deaths, 0.4%, mean age 84.0 years). Among the total cohort, the proportion living without home care or long-term care was 98.8% among persons aged 55–64 and 22.1% of those aged 95 and above. After multiple adjustment, home care and long-term care were associated with odds ratios of 7.9 (95% confidence interval [CI] 6.8–9.1) and 22.5 (95% CI 19.6–25.7) for mortality, with PAFs of 21.9% (95% CI 20.9–22.9) and 33.3% (95% CI 32.4–34.3), respectively. Conclusion: Among Swedish residents aged 55 years and above, those with home care or long-term care had markedly increased risk for COVID-19 death during the first year of the pandemic, with over 50% of deaths attributable to these factors.",

keywords = "comorbidity, COVID-19, demographics, mortality, population study, severe illness",

author = "Annika Rosengren and Lundberg, {Christina E.} and Mia S{\"o}derberg and Ailiana Santosa and Jon Edqvist and Martin Lindgren and Maria {\AA}berg and Magnus Gissl{\'e}n and Josefina Robertson and Ottmar Cronie and Naveed Sattar and Jesper Lagergren and Maria Brand{\'e}n and Jonas Bj{\"o}rk and Martin Adiels",

note = "Funding Information: This work was supported by grants from the Swedish state under an agreement concerning research and education of doctors (ALFGBG‐717211 [A. R.] and ALFGBG‐965885 [M. G.]), the Swedish Heart and Lung Foundation (2018‐0366), the Swedish Research Council (2018‐02527 [A. R.], 2020–05792 [A. R.], 2021–06545 [M. G.], VRREG 2019‐00193 [A. R.], 2019–00198 [J. B.], 2019‐00245 [M. B.], and 2019‐00209 [J. L.]), Science for Life Laboratory from the Knut and Alice Wallenberg Foundation (2020.0241) (M. G.), and the Swedish Research Council for Health, Working Life and Welfare (2021‐00304) (M. {\AA}.). Publisher Copyright: {\textcopyright} 2022 The Authors. Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine.",

year = "2022",

month = oct,

doi = "10.1111/joim.13522",

language = "English",

volume = "292",

pages = "641--653",

journal = "Journal of Internal Medicine",

issn = "0954-6820",

publisher = "Wiley-Blackwell",

number = "4",

}

Rosengren, A, Lundberg, CE, Söderberg, M, Santosa, A, Edqvist, J, Lindgren, M, Åberg, M, Gisslén, M, Robertson, J, Cronie, O, Sattar, N, Lagergren, J, Brandén, M, Björk, J & Adiels, M 2022, 'Severe COVID-19 in people 55 and older during the first year of the pandemic in Sweden', Journal of Internal Medicine, vol. 292, no. 4, pp. 641-653. https://doi.org/10.1111/joim.13522

TY - JOUR

T1 - Severe COVID-19 in people 55 and older during the first year of the pandemic in Sweden

AU - Rosengren, Annika

AU - Lundberg, Christina E.

AU - Söderberg, Mia

AU - Santosa, Ailiana

AU - Edqvist, Jon

AU - Lindgren, Martin

AU - Åberg, Maria

AU - Gisslén, Magnus

AU - Robertson, Josefina

AU - Cronie, Ottmar

AU - Sattar, Naveed

AU - Lagergren, Jesper

AU - Brandén, Maria

AU - Björk, Jonas

AU - Adiels, Martin

N1 - Funding Information: This work was supported by grants from the Swedish state under an agreement concerning research and education of doctors (ALFGBG‐717211 [A. R.] and ALFGBG‐965885 [M. G.]), the Swedish Heart and Lung Foundation (2018‐0366), the Swedish Research Council (2018‐02527 [A. R.], 2020–05792 [A. R.], 2021–06545 [M. G.], VRREG 2019‐00193 [A. R.], 2019–00198 [J. B.], 2019‐00245 [M. B.], and 2019‐00209 [J. L.]), Science for Life Laboratory from the Knut and Alice Wallenberg Foundation (2020.0241) (M. G.), and the Swedish Research Council for Health, Working Life and Welfare (2021‐00304) (M. Å.). Publisher Copyright: © 2022 The Authors. Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine.

PY - 2022/10

Y1 - 2022/10

N2 - Background: Exposure to many contacts is the main risk factor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, while risk of serious disease and death is chiefly determined by old age and comorbidities. Relative and population-attributable fractions (PAFs) of multiple medical and social exposures for COVID-19 outcomes have not been evaluated among older adults. Objectives: We describe the effect of multiple exposures on the odds of testing positive for the virus and of severe disease (hospital care or death) and PAFs in Swedish citizens aged 55 years and above. Methods: We used national registers to follow all citizens aged 55 years and above with respect to (1) testing positive, (2) hospitalization, and (3) death between 31 January 2020 and 1 February 2021. Results: Of 3,410,241 persons, 156,017 (4.6%, mean age 68.3 years) tested positive for SARS-CoV-2, while 35,999 (1.1%, mean age 76.7 years) were hospitalized or died (12,384 deaths, 0.4%, mean age 84.0 years). Among the total cohort, the proportion living without home care or long-term care was 98.8% among persons aged 55–64 and 22.1% of those aged 95 and above. After multiple adjustment, home care and long-term care were associated with odds ratios of 7.9 (95% confidence interval [CI] 6.8–9.1) and 22.5 (95% CI 19.6–25.7) for mortality, with PAFs of 21.9% (95% CI 20.9–22.9) and 33.3% (95% CI 32.4–34.3), respectively. Conclusion: Among Swedish residents aged 55 years and above, those with home care or long-term care had markedly increased risk for COVID-19 death during the first year of the pandemic, with over 50% of deaths attributable to these factors.

AB - Background: Exposure to many contacts is the main risk factor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, while risk of serious disease and death is chiefly determined by old age and comorbidities. Relative and population-attributable fractions (PAFs) of multiple medical and social exposures for COVID-19 outcomes have not been evaluated among older adults. Objectives: We describe the effect of multiple exposures on the odds of testing positive for the virus and of severe disease (hospital care or death) and PAFs in Swedish citizens aged 55 years and above. Methods: We used national registers to follow all citizens aged 55 years and above with respect to (1) testing positive, (2) hospitalization, and (3) death between 31 January 2020 and 1 February 2021. Results: Of 3,410,241 persons, 156,017 (4.6%, mean age 68.3 years) tested positive for SARS-CoV-2, while 35,999 (1.1%, mean age 76.7 years) were hospitalized or died (12,384 deaths, 0.4%, mean age 84.0 years). Among the total cohort, the proportion living without home care or long-term care was 98.8% among persons aged 55–64 and 22.1% of those aged 95 and above. After multiple adjustment, home care and long-term care were associated with odds ratios of 7.9 (95% confidence interval [CI] 6.8–9.1) and 22.5 (95% CI 19.6–25.7) for mortality, with PAFs of 21.9% (95% CI 20.9–22.9) and 33.3% (95% CI 32.4–34.3), respectively. Conclusion: Among Swedish residents aged 55 years and above, those with home care or long-term care had markedly increased risk for COVID-19 death during the first year of the pandemic, with over 50% of deaths attributable to these factors.

KW - comorbidity

KW - COVID-19

KW - demographics

KW - mortality

KW - population study

KW - severe illness

UR - http://www.scopus.com/inward/record.url?scp=85131180821&partnerID=8YFLogxK

U2 - 10.1111/joim.13522

DO - 10.1111/joim.13522

M3 - Article

C2 - 35612518

AN - SCOPUS:85131180821

SN - 0954-6820

VL - 292

SP - 641

EP - 653

JO - Journal of Internal Medicine

JF - Journal of Internal Medicine

IS - 4

ER -

Severe COVID-19 in people 55 and older during the first year of the pandemic in Sweden

Abstract

Keywords

UN SDGs

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