Marcello Morciano1,2, Jonathan Stokes3,4, Evangelos Kontopantelis4,5, Ian Hall5,6, Alex J Turner3,4. 1. Health Organisation, Policy and Economics (HOPE) Research Group, University of Manchester, Manchester, M13 9PL, UK. marcello.morciano@manchester.ac.uk. 2. NIHR School for Primary Care Research, University of Manchester, Manchester, M13 9PL, UK. marcello.morciano@manchester.ac.uk. 3. Health Organisation, Policy and Economics (HOPE) Research Group, University of Manchester, Manchester, M13 9PL, UK. 4. NIHR School for Primary Care Research, University of Manchester, Manchester, M13 9PL, UK. 5. Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, M13 9PL, UK. 6. Department of Mathematics, University of Manchester, Manchester, M13 9PL, UK.
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.
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.
Entities:
Keywords:
COVID-19; Care homes; England; Excess deaths
Authors: Jose F Figueroa; Rishi K Wadhera; Irene Papanicolas; Kristen Riley; Jie Zheng; E John Orav; Ashish K Jha Journal: JAMA Date: 2020-09-15 Impact factor: 56.272
Authors: Henriëtte G Van der Roest; Marleen Prins; Claudia van der Velden; Stephanie Steinmetz; Elske Stolte; Theo G van Tilburg; Danny H de Vries Journal: J Am Med Dir Assoc Date: 2020-09-10 Impact factor: 4.669
Authors: Chris Emmerson; James P Adamson; Drew Turner; Mike B Gravenor; Jane Salmon; Simon Cottrell; Victoria Middleton; Buffy Thomas; Brendan W Mason; Chris J Williams Journal: Influenza Other Respir Viruses Date: 2021-02-06 Impact factor: 5.606
Authors: Evangelos Kontopantelis; Mamas A Mamas; John Deanfield; Miqdad Asaria; Tim Doran Journal: J Epidemiol Community Health Date: 2020-10-15 Impact factor: 3.710
Authors: Shamez N Ladhani; Anna Jeffery-Smith; Monika Patel; Roshni Janarthanan; Jonathan Fok; Emma Crawley-Boevey; Amoolya Vusirikala; Elena Fernandez Ruiz De Olano; Marina Sanchez Perez; Suzanne Tang; Kate Dun-Campbell; Edward Wynne- Evans; Anita Bell; Bharat Patel; Zahin Amin-Chowdhury; Felicity Aiano; Karthik Paranthaman; Thomas Ma; Maria Saavedra-Campos; Joanna Ellis; Meera Chand; Kevin Brown; Mary E Ramsay; Susan Hopkins; Nandini Shetty; J Yimmy Chow; Robin Gopal; Maria Zambon Journal: EClinicalMedicine Date: 2020-11-06
Authors: Madhumita Shrotri; Maria Krutikov; Hadjer Nacer-Laidi; Borscha Azmi; Tom Palmer; Rebecca Giddings; Christopher Fuller; Aidan Irwin-Singer; Verity Baynton; Gokhan Tut; Paul Moss; Andrew Hayward; Andrew Copas; Laura Shallcross Journal: Lancet Healthy Longev Date: 2022-07-04
Authors: Peter Hanlon; Fergus Chadwick; Anoop Shah; Rachael Wood; Jon Minton; Gerry McCartney; Colin Fischbacher; Frances S Mair; Dirk Husmeier; Jason Matthiopoulos; David A McAllister Journal: Wellcome Open Res Date: 2021-03-01
Authors: Jennifer Kirsty Burton; Megan McMinn; James E Vaughan; Jacques Fleuriot; Bruce Guthrie Journal: Age Ageing Date: 2021-09-11 Impact factor: 10.668
Authors: Adam H Dyer; Claire Noonan; Matt McElheron; Isabella Batten; Conor Reddy; Emma Connolly; Rachel Pierpoint; Caroline Murray; Ann Leonard; Catriona Higgins; Phyllis Reilly; Gerard Boran; Thomas Phelan; William McCormack; Desmond O'Neill; Aoife Fallon; Gareth Brady; Cliona O'Farrelly; Nollaig M Bourke; Sean P Kennelly Journal: J Am Med Dir Assoc Date: 2022-01-11 Impact factor: 7.802
Authors: Anna Schultze; Emily Nightingale; David Evans; William Hulme; Alicia Rosello; Chris Bates; Jonathan Cockburn; Brian MacKenna; Helen J Curtis; Caroline E Morton; Richard Croker; Seb Bacon; Helen I McDonald; Christopher T Rentsch; Krishnan Bhaskaran; Rohini Mathur; Laurie A Tomlinson; Elizabeth J Williamson; Harriet Forbes; John Tazare; Daniel Grint; Alex J Walker; Peter Inglesby; Nicholas J DeVito; Amir Mehrkar; George Hickman; Simon Davy; Tom Ward; Louis Fisher; Amelia Ca Green; Kevin Wing; Angel Ys Wong; Robert McManus; John Parry; Frank Hester; Sam Harper; Stephen Jw Evans; Ian J Douglas; Liam Smeeth; Rosalind M Eggo; Ben Goldacre; David A Leon Journal: Lancet Reg Health Eur Date: 2022-01-10
Authors: Helen Strongman; Helena Carreira; Bianca L De Stavola; Krishnan Bhaskaran; David A Leon Journal: PLoS Med Date: 2022-01-06 Impact factor: 11.069