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

Abstract

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.

Hospital admissions from care homes in England during the COVID-19 pandemic: a retrospective, cross-sectional analysis using linked administrative data

“…Due to these methodological constraints, this study was designed as a crosssectional analysis of the population of residents who were living in a care home before the onset of the COVID-19 pandemic, with an adjustment for the time spend in a care home. A caveat to extrapolating these findings to the current population of care home residents is therefore that there may have been systemic changes in resident characteristics, due to the uneven impact of COVID-19 mortality across care homes, changes in care home occupancy levels or the influx of new residents [3,37,38]. While the study cohorts were comparable in observed characteristics, another limitation of observational studies is that unobserved differences between study cohorts or hospital records could have confounded the estimates.…”

“…Excess mortality attributable to COVID-19 in care homes in England up to 7th August 2020 has been estimated to be equivalent to 6.5% of care home beds [3].…”

“…Worldwide the COVID-19 pandemic has resulted in substantial excess mortality among people living in care homes [1]. Excess deaths have been attributed directly to viral infection, and to increases in deaths due to other causes, most commonly diabetes, heart diseases, Alzheimer's and dementia, and cerebrovascular diseases [2][3][4]. In England, there are two main types of care homes: residential care homes, which provide accommodation and help with personal care (such as washing, dressing and taking medication), and nursing homes, which additionally provide 24-hour support from qualified nurses.…”

Hospital Admissions From Care Homes in England During the COVID-19 Pandemic: A Retrospective, Cross-Sectional Analysis Using Linked Administrative Data

“…Due to these methodological constraints, this study was designed as a cross-sectional analysis of the population of residents who were living in a care home before the onset of the COVID-19 pandemic, with an adjustment for the time spend in a care home. A caveat to extrapolating these findings to the current population of care home residents is therefore that there may have been systemic changes in resident characteristics, due to the uneven impact of COVID-19 mortality across care homes, changes in care home occupancy levels or the influx of new residents [3,38,39]. While the study cohorts were comparable in observed characteristics, another limitation of observational studies is that unobserved differences between study cohorts or hospital records could have confounded the estimates.…”

Mortality of Care Home Residents and Community-Dwelling Controls During the COVID-19 Pandemic in 2020: Matched Cohort Study

“…9 Analysis of data reported to the Care Quality Commission (CQC) in England suggested that excess deaths represented about 6.5% of care home beds. 10 Care home residents typically have multiple risk markers for Covid-19 vulnerability, but the transmission of Covid-19 may also have been facilitated in the care home environment and outbreaks were frequent. However, rigorous epidemiological analysis has been limited and few studies included denominator data, case-mix variables or population controls.…”