Abstract
BackgroundTo estimate excess mortality for care home residents during the COVID-19 pandemic in England, exploring associations with care home characteristics.MethodsDaily 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.ResultsUp 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.ConclusionsTo 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.
Highlights
To estimate excess mortality for care home residents during the COVID-19 pandemic in England, exploring associations with care home characteristics
International evidence suggests that nearly half of all COVID-19 deaths in five European countries were amongst care home residents [2]
Branded care homes experienced significantly higher odds of one COVID-19-related death compared to independent homes, we find no evidence of increased odds associated with for-profit status
Summary
To estimate excess mortality for care home residents during the COVID-19 pandemic in England, exploring associations with care home characteristics. Residents in care homes have experienced disproportionately high morbidity and mortality from COVID-19. International evidence suggests that nearly half of all COVID-19 deaths in five European countries were amongst care home residents [2]. Attributed COVID-19 deaths do not necessarily capture the full impact on mortality, [3]. The death toll for COVID-19 relies on SARS-CoV-2 testing, with tests supply-constrained in early parts of the pandemic. Indirect fatalities due to non-COVID-19-related causes might have increased. The additional deaths observed in a given period compared to the number usually expected, better capture direct and indirect mortality impacts
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