COVID-19 risk factors amongst 14,786 care home residents: an observational longitudinal analysis including daily community positive test rates of COVID-19, hospital stays and vaccination status in Wales (UK) between 1 September 2020 and 1 May 2021

  1. Joe Hollinghurst
  2. Robyn Hollinghurst
  3. Laura North
  4. Amy Mizen
  5. Ashley Akbari
  6. Sara Long
  7. Ronan A Lyons
  8. Rich Fry

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Abstract

Background

COVID-19 vaccinations have been prioritised for high risk individuals.

Aim

Determine individual-level risk factors for care home residents testing positive for SARS-CoV-2.

Study design

Longitudinal observational cohort study using individual-level linked data from the Secure Anonymised Information Linkage (SAIL) databank.

Setting

Fourteen thousand seven hundred and eighty-six older care home residents (aged 65+) living in Wales between 1 September 2020 and 1 May 2021. Our dataset consisted of 2,613,341 individual-level daily observations within 697 care homes.

Methods

We estimated odds ratios (ORs [95% confidence interval]) using multilevel logistic regression models. Our outcome of interest was a positive SARS-CoV-2 PCR test. We included time-dependent covariates for the estimated community positive test rate of COVID-19, hospital inpatient status, vaccination status and frailty. Additional covariates were included for age, sex and specialist care home services.

Results

The multivariable regression model indicated an increase in age (OR 1.01 [1.00,1.01] per year), community positive test rate (OR 1.13 [1.12,1.13] per percent increase), hospital inpatients (OR 7.40 [6.54,8.36]), and residents in care homes with non-specialist dementia care (OR 1.42 [1.01,1.99]) had an increased odds of a positive test. Having a positive test prior to the observation period (OR 0.58 [0.49,0.68]) and either one or two doses of a vaccine (0.21 [0.17,0.25] and 0.05 [0.02,0.09], respectively) were associated with a decreased odds.

Conclusions

Care providers need to remain vigilant despite the vaccination rollout, and extra precautions should be taken when caring for the most vulnerable. Minimising potential COVID-19 infection for care home residents when admitted to hospital should be prioritised.

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  1. Version published to 10.1093/ageing/afac084
  2. ScreenIT

    SciScore for 10.1101/2021.09.30.21264338: (What is this?)

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

    Table 1: Rigor

    NIH rigor criteria are not applicable to paper type.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations: We observed a change in the testing regime from February, where the total number of tests was reduced. We did not explicitly investigate the impact of the change in testing amongst care home residents but found the care home positive test rate remained consistent in shape and magnitude compared with the estimated community positive test rate. We were unable to link all care homes in Wales in the SAIL databank (91%, 948 of 1048). We were unable to include details on care home staff who may have tested positive for SARS-CoV-2 as data on care home staff is currently cannot be linked to specific care homes. Conclusion: Our findings indicate that measures taken to prevent COVID-19 from spreading to the most vulnerable in society are not completely effective. Whilst vaccination profoundly decreased the odds of testing positive for SARS-CoV-2, there was still an increased risk of infection for vaccinated individuals admitted to hospital. We also found that an increased community positive test rate of COVID-19 was associated with an increased odds of infection in care home residents. This may reflect higher risk from visitors or care staff living locally. Achieving and maintaining very high rates of vaccination in residents, health and care staff, and visitors is essential. We suggest that care providers need to stay vigilant despite the vaccination rollout, and extra precautions should be taken when caring for the most vulnerable. Follow up research is needed to evaluat...

    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.

    Results from scite Reference Check: We found no unreliable references.

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  3. Version published to 10.1101/2021.09.30.21264338v1 on medRxiv