key: cord-0968492-z5yo6wji
authors: Sepulveda, Edgardo R.; Stall, Nathan M.; Sinha, Samir K.
title: A Comparison of COVID-19 Mortality Rates among Long-Term Care Residents in 12 OECD Countries
date: 2020-09-12
journal: J Am Med Dir Assoc
DOI: 10.1016/j.jamda.2020.08.039
sha: eaf389db39558ef20f06f6f2f6f18be6d8a11497
doc_id: 968492
cord_uid: z5yo6wji

nan

An early and persistent trend of the coronavirus disease 2019 (COVID-19) pandemic has been the large number of deaths occurring among older adults and those living in long-term care (LTC) homes. 1 Residents of LTC homes are at a disproportionately high risk of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) due to their congregant living environments, greater likelihood of being exposed to asymptomatic and pre-symptomatic care providers, and difficulty in effectively implementing infection prevention and control practices. 2, 3 The majority of LTC home residents are also older adults, for whom advanced age represents a strong risk factor for COVID-19 morbidity and mortality due to the higher prevalence of immunosenescence and chronic illnesses. 4 While the proportion of deaths occurring in LTC homes at an international level has been explored, population-specific mortality rates for LTC home residents and their comparison to rates for community-dwelling older and younger persons have neither been calculated nor analyzed. 5 Using publicly reported data on COVID-19 deaths for 12 Organization for Economic Cooperation and Development (OECD) member-countries (Belgium, Canada, Denmark, France, Germany, Ireland, Italy, Netherlands, Spain, Sweden, United Kingdom, and the United States), we calculated and compared the population-specific mortality rates and ratios for LTC home residents and community-dwelling older (age ≥65 years) and younger (age <65 years) persons.

COVID-19 deaths data were collected directly from publicly available national health and epidemiological reports and were current as of July 24, 2020 (see Appendix 1 for methodology and data sources). COVID-19 deaths included both those reported as confirmed and probable, and those that occurred in LTC home and acute hospital settings.

We report a total of 361,161 COVID-19 deaths for the 12 countries, which accounted for Ireland). (Figure 1 ).

Here we confirm a very high concentration of mortality of LTC home residents and report substantial variation between 12 OECD countries. Our results suggest that the level of community transmission, as reflected in the mortality rate for community-dwelling persons, and the level of policy response related to infection prevention and control practices in LTC homes and at the broader community level were important factors driving LTC home resident mortality rates. 5 Countries, such as Denmark and Germany, that maintained relatively low levels of community transmission and acted early and aggressively to prevent the introduction and spread of COVID-19 into their LTC homes had the lowest LTC home resident mortality rates. 7 These policy actions included the early restriction of non-essential visitors, enacting universal masking J o u r n a l P r e -p r o o f policies, improving LTC staffing levels, preventing care providers from working across multiple sites, implementing enhanced LTC infection control training and audit procedures, and widespread testing and isolation protocols for infected residents and asymptomatic contacts. 1, 8, 9 In contrast, countries such as Spain and the UK, that had relatively high levels of community transmission and less robust LTC home-related policy responses, had the highest LTC home resident mortality rates. Other countries had mixed responses with uneven results.

For instance, Canada promoted relatively forceful measures that were effective in limiting community transmission, but its LTC home-related responses were uneven and less robust for a system already characterized as being poorly staffed and funded at its baseline. 10 As some countries are still grappling with their first-waves of COVID-19 infections and others are starting to combat their second waves, understanding the factors that led to substantial mortality rates for LTC home residents in certain jurisdictions could help allow for the implementation of key policies and practices that could prevent introduction, transmission, and death from COVID-19 across all jurisdictions.

All authors received no support from any organization for the submitted work, have not entered into an agreement with any organization that has limited their ability to complete the research as planned and publish the results, have no financial relationships with any organizations that might J o u r n a l P r e -p r o o f have an interest in the submitted work, and have no other relationships or activities that could appear to have influenced the submitted work.

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