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

Anna Schultze, Emily Nightingale, David Evans, William Hulme, Alicia Rosello, Chris Bates, Jonathan Cockburn, Brian MacKenna, Helen J Curtis, Caroline E Morton, Richard Croker, Seb Bacon, Helen I McDonald, Christopher T Rentsch, Krishnan Bhaskaran, Rohini Mathur, Laurie A Tomlinson, Elizabeth J Williamson, Harriet Forbes, John TazareDaniel Grint, Alex J Walker, Peter Inglesby, Nicholas J DeVito, Amir Mehrkar, George Hickman, Simon Davy, Tom Ward, Louis Fisher, Amelia Ca Green, Kevin Wing, Angel Ys Wong, Robert McManus, John Parry, Frank Hester, Sam Harper, Stephen Jw Evans, Ian J Douglas, Liam Smeeth, Rosalind M Eggo, Ben Goldacre, David A Leon

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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.

Original languageEnglish
Article number100295
Pages (from-to)100295
JournalThe Lancet Regional Health-Europe
Volume14
Early online date10 Jan 2022
DOIs
Publication statusPublished - 31 Mar 2022
Externally publishedYes

Bibliographical note

Funding Information:
BG's work on better use of data in healthcare more broadly is currently funded in part by: NIHR Oxford Biomedical Research Centre, NIHR Applied Research Collaboration Oxford and Thames Valley, the Mohn-Westlake Foundation, NHS England, and the Health Foundation; all DataLab staff are supported by BG's grants on this work. LS reports grants from Wellcome, MRC, NIHR, UKRI, British Council, GSK, British Heart Foundation, and Diabetes UK outside this work. AS and JT are employed by LSHTM on fellowships sponsored by GSK. KB holds a Sir Henry Dale fellowship jointly funded by Wellcome and the Royal Society (107731/Z/15/Z). HIM is funded by the National Institute for Health Research (NIHR) Health Protection Research Unit in Immunisation, a partnership between Public Health England and LSHTM. AYSW holds a fellowship from BHF. ID holds grants from NIHR and GSK. RM holds a Sir Henry Wellcome Fellowship funded by the Wellcome Trust (201375/Z/16/Z). HF holds a UKRI fellowship.

Funding Information:
We are very grateful for all the support received from the TPP Technical Operations team throughout this work, and for generous assistance from the information governance and database teams at NHS England / NHSX.

Funding Information:
This work was supported by the Medical Research Council MR/V015737/1. TPP provided technical expertise and infrastructure within their data centre pro bono in the context of a national emergency.

Funding Information:
BG has received research funding from the Laura and John Arnold Foundation, the NHS National Institute for Health Research (NIHR), the NIHR School of Primary Care Research, the NIHR Oxford Biomedical Research Centre, the Mohn-Westlake Foundation, NIHR Applied Research Collaboration Oxford and Thames Valley, the Wellcome Trust, the Good Thinking Foundation, Health Data Research UK (HDRUK), the Health Foundation, and the World Health Organisation; he also receives personal income from speaking and writing for lay audiences on the misuse of science. IJD has received unrestricted research grants and holds shares in GlaxoSmithKline (GSK). RM reports personal fees from AMGEN, outside the submitted work. All other authors have nothing to declare.

Publisher Copyright:
© 2021 The Author(s)

Keywords

  • COVID-19
  • Electronic Health Records
  • Mortality
  • Nursing Homes
  • Old Age Homes

ASJC Scopus subject areas

  • Health Policy
  • Oncology
  • Internal Medicine

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