Excess Mortality After COVID-19 in Swedish Long-Term Care Facilities.
Marcel Ballin, Jonathan Bergman, Miia Kivipelto and 2 others
PMID 34174196WHAT IT FOUND
Swedish long-term care residents with confirmed COVID-19 had 30-day mortality of 39.9%, versus 5.7% in matched controls without confirmed infection.
Severe neuropsychological conditions, poor walking ability, and urinary and bowel incontinence were linked to higher mortality.
Key findings
01Thirty-day mortality was 39.9% (1487 deaths) among residents with confirmed COVID-19 and 5.7% (211 deaths) among matched controls, with a relative risk of 7.05 (95% CI 6.10-8.14).
02After adjustment, severe neuropsychological conditions, unsafe walking ability, inability to walk, and urinary and bowel incontinence were associated with higher odds of 30-day mortality.
03Diabetes, renal failure or chronic kidney disease, and previous pneumonia were associated with higher adjusted odds of 30-day mortality.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was an observational registry study, not a randomized trial, so matching cannot rule out unmeasured differences between residents with and without confirmed COVID-19. The authors had no data on symptoms at COVID-19 presentation, which may be important for mortality. The authors had no data on long-term care facility characteristics such as staffing and structure, which could affect transmission and mortality. Senior Alert records were sometimes made well before the COVID-19 date; the median time between registration and baseline was 119 days in the total cohort. The study included only residents with a Senior Alert record within 1 year before the COVID-19 date, so it may not represent all Swedish long-term care residents, although it captured 5409 of 7143 official LTCF cases. Neuropsychological conditions combined dementia and depression, so the study cannot distinguish their effects. Results may not generalize to other countries. No information on the method of testing was available.
The easy way to misread this
Do not read the 7 times higher mortality as proof that COVID-19 alone caused the excess deaths in every resident. This was an observational matched cohort, and the authors note unmeasured differences between cases and controls may have partly contributed.