Excess Mortality After COVID-19 in Swedish Long-Term Care Facilities

Ballin, Marcel; Bergman, Jonathan; Kivipelto, Miia; Nordström, Anna; Nordström, Peter

OBJECTIVE: To compare 30-day mortality in long-term care facility (LTCF) residents with and without COVID-19 and to investigate the impact of 31 potential risk factors for mortality in COVID-19 cases. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: All residents of LTCFs registered in Senior Alert, a Swedish national database of health examinations in older adults, during 2019-2020. METHODS: We selected residents with confirmed COVID-19 until September 15, 2020, along with time-dependent propensity score–matched controls without COVID-19. Exposures were COVID-19, age, sex, comorbidities, medications, and other patient characteristics. The outcome was all-cause 30-day mortality. RESULTS: A total of 3731 residents (median age 87 years, 64.5% female) with COVID-19 were matched to 3731 controls without COVID-19. Thirty-day mortality was 39.9% in COVID-19 cases and 5.7% in controls [relative risk 7.05, 95% confidence interval (CI) 6.10-8.14]. In COVID-19 cases, the odds ratio (OR) for 30-day mortality was 2.43 (95% CI 1.56-3.79) in cases aged 80-84 years, 2.98 (95% CI 1.92-4.64) in cases aged 85-89 years, and 3.26 (95% CI 2.09-5.06) in cases aged ≥90 years, as compared with cases aged <70 years. Other risk factors for mortality among COVID-19 cases included male sex (OR, 2.56, 95% CI 2.19-3.00), neuropsychological conditions (OR, 2.18; 95% CI 1.75-2.70), impaired walking ability (OR, 1.46, 95% CI 1.19-1.80), urinary and bowel incontinence (OR 1.50, 95% CI 1.22-1.85), diabetes (OR 1.36, 95% CI 1.14-1.62), chronic kidney disease (OR 1.37, 95% CI 1.11-1.69) and previous pneumonia (OR 1.57, 95% CI 1.32-1.85). Nutritional factors, cardiovascular diseases, and antihypertensive medications were not significantly associated with mortality. CONCLUSIONS AND IMPLICATIONS: In Swedish LTCFs, COVID-19 was associated with a large excess in mortality after controlling for a large number of risk factors. Beyond older age and male sex, several prevalent clinical risk factors independently contributed to higher mortality. These findings suggest that reducing transmission of COVID-19 in LTCFs will likely prevent a considerable number of deaths.