Mortality of care home residents and community-dwelling controls during the covid-19 pandemic in 2020: matched cohort study

Objective: To estimate mortality of care home residents during the Covid-19 pandemic from primary care electronic health records. Design: Matched cohort study Setting: 1,421 general practices contributing to the Clinical Practice Research Datalink Aurum Database in England. Participants: 217,987 patients aged 18 to 104 years with recorded care home residence in England in the period 2015 to 2020. There were 86,371 care home residents contributing data in 2020, with 29,662 deaths; 83,419 (97%) were matched on age, gender and general practice with 312,607 community-dwelling adults. Main outcome measures: All-cause mortality. Analysis was by Poisson regression adjusting for age, gender, long-term conditions, region, year and calendar week. Results: The highest first wave age-specific mortality rate was 6.02 (95% confidence interval 5.97 to 6.07) per 100 patients per week in men aged 95-104 years between 13th-19th April 2020. Compared with community-dwelling controls, the adjusted rate ratio for mortality of care home residents was 4.95 (4.62 to 5.32) in February 2020, increasing to 8.34 (7.95 to 8.74) in April 2020, declining to 3.93 (3.68 to 4.20) in December 2020. During the week of 13th to 19th April 2020, mortality of care home residents was 10.74 (9.72 to 11.85) times higher than for matched community-dwelling controls. Conclusions: Individual-patient data from primary care electronic health records may be used to estimate mortality in care home residents. Mortality is substantially higher than for community-dwelling comparators and showed a disproportionate increase in the first wave of the Covid-19 pandemic but not the second wave. This study provides evidence to support earlier, decisive action to protect these vulnerable populations in the event of further outbreaks. Prospective investigations of care home mortality are warranted.