Excess mortality for care home residents during the first 23 weeks of the COVID-19 pandemic in England: a national cohort study

Morciano, M., Stokes, J. , Kontopantelis, E., hall, i. and Turner, A. J. (2021) Excess mortality for care home residents during the first 23 weeks of the COVID-19 pandemic in England: a national cohort study. BMC Medicine, 19, 71. (doi: 10.1186/s12916-021-01945-2) (PMID:33663498) (PMCID:PMC7932761)

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Background: To estimate excess mortality for care home residents during the COVID-19 pandemic in England, exploring associations with care home characteristics. Methods: Daily number of deaths in all residential and nursing homes in England notified to the Care Quality Commission (CQC) from 1 January 2017 to 7 August 2020. Care home-level data linked with CQC care home register to identify home characteristics: client type (over 65s/children and adults), ownership status (for-profit/not-for-profit; branded/independent) and size (small/medium/large). Excess deaths computed as the difference between observed and predicted deaths using local authority fixed-effect Poisson regressions on pre-pandemic data. Fixed-effect logistic regressions were used to model odds of experiencing COVID-19 suspected/confirmed deaths. Results: Up to 7 August 2020, there were 29,542 (95% CI 25,176 to 33,908) excess deaths in all care homes. Excess deaths represented 6.5% (95% CI 5.5 to 7.4%) of all care home beds, higher in nursing (8.4%) than residential (4.6%) homes. 64.7% (95% CI 56.4 to 76.0%) of the excess deaths were confirmed/suspected COVID-19. Almost all excess deaths were recorded in the quarter (27.4%) of homes with any COVID-19 fatalities. The odds of experiencing COVID-19 attributable deaths were higher in homes providing nursing services (OR 1.8, 95% CI 1.6 to 2.0), to older people and/or with dementia (OR 5.5, 95% CI 4.4 to 6.8), amongst larger (vs. small) homes (OR 13.3, 95% CI 11.5 to 15.4) and belonging to a large provider/brand (OR 1.2, 95% CI 1.1 to 1.3). There was no significant association with for-profit status of providers. Conclusions: To limit excess mortality, policy should be targeted at care homes to minimise the risk of ingress of disease and limit subsequent transmission. Our findings provide specific characteristic targets for further research on mechanisms and policy priority.

Item Type:Articles
Additional Information:MM, JS and AT are part-funded by the National Institute for Health Research (NIHR) Applied Research Collaboration for Greater Manchester and the NIHR School for Primary Care Research (SPCR-2014-10043, grant ref. no. 474). MM is also part-funded by the NIHR Policy Research Unit in Health and Social Care Systems and Commissioning (PRUComm, PR-PRU-1217-20801). JS is additionally supported by an MRC Fellowship (MR/T027517/1). IH is a principal investigator of the NIHR Policy Research Programme in Operational Research for Emergency Response Analysis (OPERA, PR-R17-0916-21001).
Keywords:COVID-19, Care homes, England, Excess deaths
Glasgow Author(s) Enlighten ID:Stokes, Dr Jonathan
Authors: Morciano, M., Stokes, J., Kontopantelis, E., hall, i., and Turner, A. J.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
Journal Name:BMC Medicine
Publisher:BioMed Central
ISSN (Online):1741-7015
Published Online:05 March 2021
Copyright Holders:Copyright © The Author(s) 2021
First Published:First published in BMC Medicine 19: 71
Publisher Policy:Reproduced under a Creative Commons License

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