The Lancet Regional Health. Europe (Mar 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
- 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 Tazare,
- Daniel 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
Affiliations
- Anna Schultze
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT; Corresponding author: Dr Anna Schultze, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT.
- Emily Nightingale
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT
- David Evans
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG
- William Hulme
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG
- Alicia Rosello
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT
- Chris Bates
- TPP, TPP House, 129 Low Lane, Horsforth, Leeds, LS18 5PX
- Jonathan Cockburn
- TPP, TPP House, 129 Low Lane, Horsforth, Leeds, LS18 5PX
- Brian MacKenna
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG
- Helen J Curtis
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG
- Caroline E Morton
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG
- Richard Croker
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG
- Seb Bacon
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG
- Helen I McDonald
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT
- Christopher T Rentsch
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT
- Krishnan Bhaskaran
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT
- Rohini Mathur
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT
- Laurie A Tomlinson
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT
- Elizabeth J Williamson
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT
- Harriet Forbes
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT
- John Tazare
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT
- Daniel Grint
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT
- Alex J Walker
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG
- Peter Inglesby
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG
- Nicholas J DeVito
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG
- Amir Mehrkar
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG
- George Hickman
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG
- Simon Davy
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG
- Tom Ward
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG
- Louis Fisher
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG
- Amelia CA Green
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG
- Kevin Wing
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT
- Angel YS Wong
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT
- Robert McManus
- TPP, TPP House, 129 Low Lane, Horsforth, Leeds, LS18 5PX
- John Parry
- TPP, TPP House, 129 Low Lane, Horsforth, Leeds, LS18 5PX
- Frank Hester
- TPP, TPP House, 129 Low Lane, Horsforth, Leeds, LS18 5PX
- Sam Harper
- TPP, TPP House, 129 Low Lane, Horsforth, Leeds, LS18 5PX
- Stephen JW Evans
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT
- Ian J Douglas
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT
- Liam Smeeth
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT
- Rosalind M Eggo
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT
- Ben Goldacre
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG
- David A Leon
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT; Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway; International Laboratory For Population and Health, National Research University Higher School of Economics, Moscow, Russia
- Journal volume & issue
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Vol. 14
p. 100295
Abstract
Summary: 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
