The impact of COVID-19 on adjusted mortality risk in care homes for older adults in Wales, UK: a retrospective population-based cohort study for mortality in 2016-2020.

Joe Hollinghurst,Jane Lyons,Mike Gravenor,Fiona Verity,Alan Watkins,Ronan A Lyons,Ashley Akbari,Richard Fry

doi:10.1093/ageing/afaa207

Abstract

Backgroundmortality in care homes has had a prominent focus during the COVID-19 outbreak. Care homes are particularly vulnerable to the spread of infectious diseases, which may lead to increased mortality risk. Multiple and interconnected challenges face the care home sector in the prevention and management of outbreaks of COVID-19, including adequate supply of personal protective equipment, staff shortages and insufficient or lack of timely COVID-19 testing.Aimto analyse the mortality of older care home residents in Wales during COVID-19 lockdown and compare this across the population of Wales and the previous 4 years.Study Design and Settingwe used anonymised electronic health records and administrative data from the secure anonymised information linkage databank to create a cross-sectional cohort study. We anonymously linked data for Welsh residents to mortality data up to the 14th June 2020.Methodswe calculated survival curves and adjusted Cox proportional hazards models to estimate hazard ratios (HRs) for the risk of mortality. We adjusted HRs for age, gender, social economic status and prior health conditions.Resultssurvival curves show an increased proportion of deaths between 23rd March and 14th June 2020 in care homes for older people, with an adjusted HR of 1.72 (1.55, 1.90) compared with 2016. Compared with the general population in 2016–2019, adjusted care home mortality HRs for older adults rose from 2.15 (2.11, 2.20) in 2016–2019 to 2.94 (2.81, 3.08) in 2020.Conclusionsthe survival curves and increased HRs show a significantly increased risk of death in the 2020 study periods.

Highlights

BackgroundMortality in care homes has had a prominent worldwide focus during the COVID-19 outbreak [1,2] but few detailed analyses have been conducted
Our cohorts were created using data held within the Secure Anonymised Information Linkage (SAIL) Databank [17,18,19]. e SAIL Databank contains longitudinal anonymised administrative and healthcare records for the population of Wales. e anonymisation is performed by a trusted third party, the National Health Service (NHS) Wales Informatics Service (NWIS). e SAIL Databank has a unique individual anonymised person identifier known as an Anonymous Linking Field (ALF) and unique address anonymised identifier known as a Residential ALF (RALF) [20] that are used to link between data sources at individual and residential levels, respectively
We determined if someone was a care home resident by linking their de-identified address information to the residences indexed as a care home in the Welsh Demographic Service Dataset (WDSD). e anonymised care home index was created using the Care Inspectorate Wales (CIW) [22] data source from 2018 and assigning a Unique Property Reference Number (UPRN) to each address [23]

Summary

Introduction

BackgroundMortality in care homes has had a prominent worldwide focus during the COVID-19 outbreak [1,2] but few detailed analyses have been conducted. Ey provide accommodation and care for those needing substantial help with personal care, but more than that, they are people’s homes [2,3]. Care home markets vary across the 22 local government authorities in Wales in the supply, ownership and size of care homes [5]. While the main providers are single operators of one home, care homes are owned by local authorities, small operators (2–3 care homes) and large operators (4 or more care homes) [5]. E Commissioner’s expectations for change were far ranging and included greater investment in the care home sector, staff development, recalibrating a human rights focus, quality reporting and provision of a range of health services [6] Following a wide reaching inquiry into quality of life and care in care homes, the Older Person’s Commissioner for Wales concluded that ‘too many older people living in care homes have an unacceptable quality of life’ [6]. e Commissioner’s expectations for change were far ranging and included greater investment in the care home sector, staff development, recalibrating a human rights focus, quality reporting and provision of a range of health services [6]

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