The impact of COVID-19 on adjusted mortality risk in care homes for older adults in Wales, UK: a retrospective population-based cohort study for mortality in 2016–2020

• Published in: Age and ageing Vol. 50; no. 1; pp. 25 - 31
• Main Authors: Hollinghurst, Joe, Lyons, Jane, Fry, Richard, Akbari, Ashley, Gravenor, Mike, Watkins, Alan, Verity, Fiona, Lyons, Ronan A
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 08-01-2021; Oxford Publishing Limited (England)
• Subjects: Aged; Cohort analysis; Computerized medical records; Coronaviruses; COVID-19; COVID-19 - mortality; COVID-19 - prevention & control; COVID-19 - therapy; COVID-19 diagnostic tests; COVID-19 Testing - methods; COVID-19 Testing - standards; Economic status; Electronic medical records; Epidemics; Female; Health records; Health status; Health Status Disparities; Homes for the Aged - statistics & numerical data; Humans; Infection Control - methods; Infection Control - organization & administration; Infection Control - statistics & numerical data; Infectious diseases; Male; Mortality; Needs Assessment; Nursing Homes - statistics & numerical data; Older people; Outbreaks; Personal Protective Equipment - supply & distribution; Population studies; Population-based studies; Research Paper; Residential care; Risk Assessment; SARS-CoV-2 - isolation & purification; Shortages; Survival; Wales - epidemiology; Workload - standards; Wales; United Kingdom > UK; COVID-19; mortality; frailty; older people; care homes
• ISSN: 0002-0729; 1468-2834
• DOI: 10.1093/ageing/afaa207

Abstract
Background
mortality in care homes has had a prominent focus during the COVID-19 outbreak. Care homes are particularly vulnerable to the spread of infectious diseases, which may lead to increased mortality risk. Multiple and interconnected challenges face the care home sector in the prevention and management of outbreaks of COVID-19, including adequate supply of personal protective equipment, staff shortages and insufficient or lack of timely COVID-19 testing.
Aim
to analyse the mortality of older care home residents in Wales during COVID-19 lockdown and compare this across the population of Wales and the previous 4 years.
Study Design and Setting
we used anonymised electronic health records and administrative data from the secure anonymised information linkage databank to create a cross-sectional cohort study. We anonymously linked data for Welsh residents to mortality data up to the 14th June 2020.
Methods
we calculated survival curves and adjusted Cox proportional hazards models to estimate hazard ratios (HRs) for the risk of mortality. We adjusted HRs for age, gender, social economic status and prior health conditions.
Results
survival curves show an increased proportion of deaths between 23rd March and 14th June 2020 in care homes for older people, with an adjusted HR of 1.72 (1.55, 1.90) compared with 2016. Compared with the general population in 2016–2019, adjusted care home mortality HRs for older adults rose from 2.15 (2.11, 2.20) in 2016–2019 to 2.94 (2.81, 3.08) in 2020.
Conclusions
the survival curves and increased HRs show a significantly increased risk of death in the 2020 study periods.