Impact of COVID-19 on Care-Home Mortality and Life Expectancy in Scotland

Burton, Jennifer K; Reid, Martin; Gribben, Ciara; Caldwell, David; Clark, David N; Hanlon, Peter; Quinn, Terence J; Fischbacher, Colin; Knight, Peter; Guthrie, Bruce; McAllister, David A

BACKGROUND: COVID-19 deaths are commoner among care-home residents, but the mortality burden has not been quantified. METHODS: Care-home residency was identified via a national primary care registration database linked to mortality data. Life expectancy was estimated using Makeham-Gompertz models, to (i) describe yearly life expectancy from November 2015 to October 2020 (ii) compare life expectancy (during 2016–2018) between care-home residents and the wider population and (iii) apply care-home life expectancy estimates to COVID-19 death counts to estimate years of life lost (YLL). RESULTS: Among care-home residents, life expectancy in 2015/16 to 2019/20 ranged from 2.7 to 2.3 years for women and 2.3 to 1.8 years for men. Age-sex specific life expectancy in 2016–2018 in care-home residents was lower than in the Scottish population (10 and 2.5 years in those aged 70 and 90 respectively). Applying care-home specific life expectancies to COVID-19 deaths yields, mean YLLs for care-home residents of 2.6 and 2.2 for women and men respectively. In total YLL care-home residents have lost 3,560 years in women and 2,046 years in men. Approximately half of deaths and a quarter of YLL attributed to COVID-19 were accounted for by the 5% of over-70s who were care-home residents. CONCLUSION: COVID-19 infection has led to the loss of substantial years of life in care-home residents aged 70 years and over in Scotland. Prioritising the 5% of older adults who are care-home residents for vaccination is justified not only in terms of total deaths, but also in terms of years of life lost.