Impact of COVID-19 on care-home mortality and life expectancy in Scotland

  1. Jennifer K Burton
  2. Martin Reid
  3. Ciara Gribben
  4. David Caldwell
  5. David N Clark
  6. Peter Hanlon
  7. Terence J Quinn
  8. Colin Fischbacher
  9. Peter Knight
  10. Bruce Guthrie
  11. David A McAllister

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Abstract

Background

COVID-19 deaths are commoner among care-home residents, but the mortality burden has not been quantified.

Methods

Care-home residency was identified via a national primary care registration database linked to mortality data. Life expectancy was estimated using Makeham–Gompertz models to (i) describe yearly life expectancy from November 2015 to October 2020 (ii) compare life expectancy (during 2016–18) between care-home residents and the wider population and (iii) apply care-home life expectancy estimates to COVID-19 death counts to estimate years of life lost (YLL).

Results

Among care-home residents, life expectancy in 2015/16 to 2019/20 ranged from 2.7 to 2.3 years for women and 2.3 to 1.8 years for men. Age–sex-specific life expectancy in 2016–18 in care-home residents was lower than in the Scottish population (10 and 2.5 years in those aged 70 and 90, respectively). Applying care home-specific life expectancies to COVID-19 deaths yield mean YLLs for care-home residents of 2.6 and 2.2 for women and men, respectively. In total YLL care-home residents have lost 3,560 years in women and 2,046 years in men. Approximately half of deaths and a quarter of YLL attributed to COVID-19 were accounted for by the 5% of over-70s who were care-home residents.

Conclusion

COVID-19 infection has led to the loss of substantial years of life in care-home residents aged 70 years and over in Scotland. Prioritising the 5% of older adults who are care-home residents for vaccination is justified not only in terms of total deaths, but also in terms of YLL.

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  1. Version published to 10.1093/ageing/afab080
  2. ScreenIT

    SciScore for 10.1101/2021.01.15.21249871: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: Thank you for sharing your code and data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations of the study: This analysis is based on Scotland-wide registration systems and is therefore highly representative. Use of anonymised, linked routinely collected data is inclusive, and not reliant on individual consent – an important consideration when analysing data on the population living in care-homes as it will lead to reduced bias.28 GP registration is necessary as a means of accessing primary healthcare in Scotland and thus is likely to represent a highly representative sampling frame when the focus is on individuals aged 70 years and over. Our validation work using UPRN in 2020 is reassuring in terms of the accuracy of the CHI-based identification of care-home status. Nonetheless, under-ascertainment of care-home residents is possible, though difficult to quantify. Data are published on care-home places (around 40,000 in 2020), but occupancy is not routinely collected or reported and some care-homes operate exclusively for non-resident short-stays and respite care. Previous analyses identified around 35,000 long-stay residents in Scotland’s care-homes at all ages19 and our data broadly align with these figures. However, we are likely to have missed those with very short care-home stays (e.g. those discharged to care-homes for end of life care who die before their registered address is changed), and our findings cannot be applied to such individuals. It is important to note that the life expectancy estimates presented are the average across care-home residen...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

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  3. Version published to 10.1101/2021.01.15.21249871v1 on medRxiv