Magnitude, change over time, demographic characteristics and geographic distribution of excess deaths among nursing home residents during the first wave of COVID-19 in France: a nationwide cohort study

Abstract

Background: The objectives were to assess the excess deaths among Nursing Home (NH) residents during the first wave of the COVID-19 pandemic, to determine their part in the total excess deaths and whether there was a mortality displacement. Methods: We studied a cohort of 494,753 adults in 6,515 NHs in France exposed to COVID-19 pandemic (from March 1st to May 31st, 2020) and compared with the 2014–2019 cohorts using data from the French National Health Data System. The main outcome was death. Excess deaths and standardized mortality ratios (SMRs) were estimated. Result: There were 13,505 excess deaths. Mortality increased by 43% (SMR: 1.43). The mortality excess was higher among males than females (SMR: 1.51 and 1.38) and decreased with increasing age (SMRs in females: 1.61 in the 60–74 age group, 1.58 for 75–84, 1.41 for 85–94, and 1.31 for 95 or over; Males: SMRs: 1.59 for 60–74, 1.69 for 75–84, 1.47 for 85–94, and 1.41 for 95 or over). No mortality displacement effect was observed up until August 30th,2020. By extrapolating to all NH residents nationally (N = 570,003), we estimated that they accounted for 51% of the general population excess deaths (N = 15,114 out of 29,563). Conclusion: NH residents accounted for half of the total excess deaths in France during the first wave of the COVID-19 pandemic. The excess death rate was higher among males than females and among younger than older residents.

COVID-19 in French nursing homes during the second pandemic wave: a mixed-methods cross-sectional study

“…Strict lockdowns in our cohort were associated with higher FTTS incidence, triggered by individuals’ difficult living conditions over multiple months (the long duration of the crisis, an anxiety-provoking atmosphere, social isolation, other residents’ deaths, etc). We found a strong statistical association between COVID-19 case fatality and FTTS diagnoses, a result that was triangulated by qualitative interview data and is consistent with other research from France,42 the UK,43 Finland,47 the USA,48 Spain49 50 and Italy 51…”

“…Finally, the benefit of confining residents to their rooms is strongly questioned by these results. While such measures undeniably reduce virus transmission among residents,6–10 14 15 34 38 39 42–44 the consequences for their mental health and nutritional status have also been shown to be considerable 12 13 20–24 37 45–49. Strict lockdowns in our cohort were associated with higher FTTS incidence, triggered by individuals’ difficult living conditions over multiple months (the long duration of the crisis, an anxiety-provoking atmosphere, social isolation, other residents’ deaths, etc).…”

Estimation de la surmortalité dans les régions françaises et espagnoles pendant la première vague de Covid-19 : application de la méthode « après/avant »

“…Nous voulions mettre en lumière l'importance des mesures de surmortalité et fournir des éléments probants concernant les estimations de surmortalité à l'échelle infranationale, et ainsi combler une lacune dans la littérature consacrée aux disparités régionales de surmortalité en France et en Espagne. De précédentes analyses effectuées pour des régions françaises s'étaient servies d'un intervalle de temps plus bref (Fouillet et al, 2020) que celui utilisé ici, ou d'une population cible spécifique, par exemple les résidents d'établissements médicalisés (Canouï-Poitrine et al, 2021). Les taux de surmortalité espagnols ont été analysés dans une prépublication, uniquement au niveau national et pour l'ensemble de l'année 2020 (Martín-Olalla, 2021).…”

SARS-CoV-2 in Nursing Homes: Analysis of Routine Surveillance Data in Four European Countries

“…Old age was found to be the main risk-factor for the severity of SARS-CoV-2 infection, prompting nursing homes to adopt strategies to prevent introduction and spread of the disease among residents [1][2][3][4][5][6][7]. Yet, it seems that mortality by COVID-19 was higher in elderly living in nursing homes.…”

“…Yet, it seems that mortality by COVID-19 was higher in elderly living in nursing homes. Such differences may be explained by repeated uncontrolled outbreaks in closed environments, but could also be a consequence of the poorer health status of nursing home residents compared to elderly living in the community [3,4]. The huge diversity in nursing home organization and adoption of control measures adds to the difficulty in interpretation [8].…”