Mortality of Care Home Residents and Community-Dwelling Controls During the COVID-19 Pandemic in 2020: Matched Cohort Study.
Martin C Gulliford, A Toby Prevost, Andrew Clegg and 1 others
PMID 35561757WHAT IT FOUND
Care home residents had much higher mortality than matched community controls.
In April 2020, after accounting for the underlying difference and the April increase in controls, their mortality rate rose a further 76%.
Key findings
01After adjustment, care home residents had an overall mortality rate ratio of 5.59 (5.23 to 5.99) compared with matched community controls.
02In April 2020, after allowing for the underlying difference between groups and the April increase in controls, care home residents had a further 76% (60% to 93%) relative increase in mortality.
03Mortality was higher in men than women and increased with age, long-term conditions, and frailty, but the effects of long-term conditions and frailty were greater in community controls than in care home residents.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study could not separate the effect of residents' health status from the shared care home environment, so residual confounding may remain. Care home residence may have been misclassified or under-recorded in primary care records. Limited testing and recording of COVID-19 may have underestimated the burden of infection early in the pandemic. The researchers did not know whether community controls were receiving social or nursing care at home, which may be related to frailty. The records did not identify individual care homes, so clustering of deaths within the same care home could not be analysed. Deprivation and ethnicity were not adjusted for, and both may affect mortality risk.
The easy way to misread this
Do not read the higher mortality of care home residents as proof that care homes caused the deaths. The study could not separate residents' health status from the care home environment, and residual confounding, misclassification, and limited COVID-19 testing may affect the estimates.