Abstract
The coronavirus disease 2019 (COVID-19) has had devastating consequences worldwide, including a spike in global mortality. Residents of long-term care homes have been disproportionately affected. We conducted a retrospective cohort study to determine the scale of pandemic-related deaths of long-term care residents in the province of Ontario, Canada, and to estimate excess mortality due to a positive COVID-19 test adjusted for demographics and regional variations. Crude mortality rates for 2019 and 2020 were compared, as were predictors of mortality among residents with positive and negative tests from March 2020 to December 2020. We found the crude mortality rates were higher from April 2020 to June 2020 and from November 2020 to December 2020, corresponding to Wave 1 and Wave 2 of the pandemic in Ontario. There were also substantial increases in mortality among residents with a positive COVID-19 test. The significant differences in excess mortality observed in relation to long-term care home ownership category and geographic region may indicate gaps in the healthcare system that warrant attention from policymakers. Further investigation is needed to identify the most relevant factors in explaining these differences.
Highlights
The coronavirus disease 2019 (COVID-19) has had devastating consequences worldwide, including a spike in global mortality
The data underlying the results presented in the study are available from the Institute for Clinical Evaluative Sciences (ICES) who can be contacted at https://www.ices.on.ca/About-ICES/ ICES-Contacts-and-Sites/contact
Using resident-level data from linked health administrative databases, this paper provides an analysis of the scale of COVID-19 deaths among long-term care (LTC) residents to further assess the extent of excess mortality from infection
Summary
The coronavirus disease 2019 (COVID-19) has had devastating consequences worldwide, including a spike in global mortality. One group that has been disproportionately affected are residents of long-term care (LTC) homes. Compared with other Organisation for Economic Co-operation and Development countries, Canada had a relatively low overall COVID-19 mortality rate but the highest proportion of LTC deaths. Residents of LTC homes in Canada represented 81% of all reported COVID-19 deaths compared with an average of 38% in other countries [1]. Countries have reported a significant number of COVID-related deaths in LTC settings. In Sweden, more than 50% of all deaths occurred in LTC homes, the highest among the Scandinavian countries [2]. In Italy, municipalities with care homes had higher rates of excess deaths related to COVID compared to those without a care home [3].
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