The impact of COVID-19 infection on social care use in people over 50 years of age: a matched cohort study

Objectives

To estimate the impact of COVID-19 infection on the requirement for social care services among adults aged ≥50 years in North-West London.

Design

Population based matched cohort study using linked routinely collected electronic social care, primary care and hospital records (the Discover dataset).

Setting

Approximately 4.7 million people with a general practitioner record in North-West London.

Participants

150,654 adults aged ≥50 years with a first diagnosis of COVID-19 between January 2020 and February 2023 and 547,704 propensity score matched comparators without a COVID-19 diagnosis during the same period.

Main outcome measures

Social care use and associated costs overall and by specific type (care home, domiciliary care, respite care, social care assessments) stratified by age group, index year, diagnosis setting, severe COVID-19 risk status, frailty, and care home admission prior to index. Overall survival.

Results

A total of 9,174 (6.09%) individuals with COVID-19 required social care use (of any type) during follow up, 2.54 times (95%CI: 2.48-2.61; P<0.0001) higher than matched comparators (n=13,126, 2.40%). The difference was largest for care home admission; individuals with COVID-19 had 4.10 (95%CI: 3.87-4.36; P<0.0001) times the risk of a care home admission and nearly twice the risk (risk ratio 1.94; 95%CI:1.86-2.02 P<0.0001) of domiciliary care during follow up compared with matched comparators. Individuals with COVID-19 experienced higher mortality, with 9.30% (14,005/547,704) dying during follow up compared with 3.76% (20,608/547,704) deaths among matched comparators.

This increase in social care utilisation was observed for all age groups. Adults with COVID-19 had over four times higher social care costs than matched comparators (£1,276 per person per year (pppy) versus £276 pppy; mean difference +£1000, 95%CI: £947-£1054, p<0.0001), with most of the costs due to care home admissions. Higher social care costs in individuals with COVID-19 compared with matched comparators were strongly age related, rising from a mean difference of £130 pppy (95%CI: £99-£161) in those aged 50-64 to £6108 pppy (95%CI: £5613-£6603) higher costs in those aged ≥ 85.

Conclusions

COVID-19 infection is associated with meaningfully higher social care requirements in the ≥50 years population. Reducing the need for social care use and the associated costs of care should be one of the goals of interventions to reduce the risk and severity of COVID-19 infection.