COVID-19 risk factors amongst 14,786 care home residents: an observational longitudinal analysis including daily community positive test rates of COVID-19, hospital stays and vaccination status in Wales (UK) between 1 September 2020 and 1 May 2021

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Abstract

Background

COVID-19 vaccinations have been prioritised for high risk individuals.

Aim

Determine individual-level risk factors for care home residents testing positive for SARS-CoV-2.

Study design

Longitudinal observational cohort study using individual-level linked data from the Secure Anonymised Information Linkage (SAIL) databank.

Setting

Fourteen thousand seven hundred and eighty-six older care home residents (aged 65+) living in Wales between 1 September 2020 and 1 May 2021. Our dataset consisted of 2,613,341 individual-level daily observations within 697 care homes.

Methods

We estimated odds ratios (ORs [95% confidence interval]) using multilevel logistic regression models. Our outcome of interest was a positive SARS-CoV-2 PCR test. We included time-dependent covariates for the estimated community positive test rate of COVID-19, hospital inpatient status, vaccination status and frailty. Additional covariates were included for age, sex and specialist care home services.

Results

The multivariable regression model indicated an increase in age (OR 1.01 [1.00,1.01] per year), community positive test rate (OR 1.13 [1.12,1.13] per percent increase), hospital inpatients (OR 7.40 [6.54,8.36]), and residents in care homes with non-specialist dementia care (OR 1.42 [1.01,1.99]) had an increased odds of a positive test. Having a positive test prior to the observation period (OR 0.58 [0.49,0.68]) and either one or two doses of a vaccine (0.21 [0.17,0.25] and 0.05 [0.02,0.09], respectively) were associated with a decreased odds.

Conclusions

Care providers need to remain vigilant despite the vaccination rollout, and extra precautions should be taken when caring for the most vulnerable. Minimising potential COVID-19 infection for care home residents when admitted to hospital should be prioritised.

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Most cited references 22

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Development and validation of a Hospital Frailty Risk Score focusing on older people in acute care settings using electronic hospital records: an observational study

Thomas I. Gilbert, Jenny Neuburger, Joshua Kraindler … (2018)

Summary Background Older people are increasing users of health care globally. We aimed to establish whether older people with characteristics of frailty and who are at risk of adverse health-care outcomes could be identified using routinely collected data. Methods A three-step approach was used to develop and validate a Hospital Frailty Risk Score from International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnostic codes. First, we carried out a cluster analysis to identify a group of older people (≥75 years) admitted to hospital who had high resource use and diagnoses associated with frailty. Second, we created a Hospital Frailty Risk Score based on ICD-10 codes that characterised this group. Third, in separate cohorts, we tested how well the score predicted adverse outcomes and whether it identified similar groups as other frailty tools. Findings In the development cohort (n=22 139), older people with frailty diagnoses formed a distinct group and had higher non-elective hospital use (33·6 bed-days over 2 years compared with 23·0 bed-days for the group with the next highest number of bed-days). In the national validation cohort (n=1 013 590), compared with the 429 762 (42·4%) patients with the lowest risk scores, the 202 718 (20·0%) patients with the highest Hospital Frailty Risk Scores had increased odds of 30-day mortality (odds ratio 1·71, 95% CI 1·68–1·75), long hospital stay (6·03, 5·92–6·10), and 30-day readmission (1·48, 1·46–1·50). The c statistics (ie, model discrimination) between individuals for these three outcomes were 0·60, 0·68, and 0·56, respectively. The Hospital Frailty Risk Score showed fair overlap with dichotomised Fried and Rockwood scales (kappa scores 0·22, 95% CI 0·15–0·30 and 0·30, 0·22–0·38, respectively) and moderate agreement with the Rockwood Frailty Index (Pearson's correlation coefficient 0·41, 95% CI 0·38–0·47). Interpretation The Hospital Frailty Risk Score provides hospitals and health systems with a low-cost, systematic way to screen for frailty and identify a group of patients who are at greater risk of adverse outcomes and for whom a frailty-attuned approach might be useful. Funding National Institute for Health Research.

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The SAIL databank: linking multiple health and social care datasets

Ronan Lyons, Kerina Jones, Gareth John … (2009)

Background Vast amounts of data are collected about patients and service users in the course of health and social care service delivery. Electronic data systems for patient records have the potential to revolutionise service delivery and research. But in order to achieve this, it is essential that the ability to link the data at the individual record level be retained whilst adhering to the principles of information governance. The SAIL (Secure Anonymised Information Linkage) databank has been established using disparate datasets, and over 500 million records from multiple health and social care service providers have been loaded to date, with further growth in progress. Methods Having established the infrastructure of the databank, the aim of this work was to develop and implement an accurate matching process to enable the assignment of a unique Anonymous Linking Field (ALF) to person-based records to make the databank ready for record-linkage research studies. An SQL-based matching algorithm (MACRAL, Matching Algorithm for Consistent Results in Anonymised Linkage) was developed for this purpose. Firstly the suitability of using a valid NHS number as the basis of a unique identifier was assessed using MACRAL. Secondly, MACRAL was applied in turn to match primary care, secondary care and social services datasets to the NHS Administrative Register (NHSAR), to assess the efficacy of this process, and the optimum matching technique. Results The validation of using the NHS number yielded specificity values > 99.8% and sensitivity values > 94.6% using probabilistic record linkage (PRL) at the 50% threshold, and error rates were < 0.2%. A range of techniques for matching datasets to the NHSAR were applied and the optimum technique resulted in sensitivity values of: 99.9% for a GP dataset from primary care, 99.3% for a PEDW dataset from secondary care and 95.2% for the PARIS database from social care. Conclusion With the infrastructure that has been put in place, the reliable matching process that has been developed enables an ALF to be consistently allocated to records in the databank. The SAIL databank represents a research-ready platform for record-linkage studies.

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Efficacy and safety of COVID-19 vaccines in older people

Roy Soiza, Chiara Scicluna, Emma Thomson (2020)

Abstract Several vaccines against coronavirus disease 2019 (COVID-19) are on the cusp of regulatory approval. Their safety and efficacy in older people is critical to their success. Even though care home residents and older people are likely to be amongst the first to be vaccinated, these patient groups are usually excluded from clinical trials. Data from several Phase II trials have given cause for optimism, with strong antibody responses and reassuring safety profiles but, with the exception of AstraZeneca’s vaccine, recruited few older people. Overall, the sparse data from Phase II trials suggest a reduction in both antibody responses and mild to moderate adverse events in well older people compared to younger participants. Many of the Phase III trials have made a conscious effort to recruit older people, and interim analyses of the Pfizer and Moderna vaccine have led to press releases announcing high degrees of efficacy. However, older people with co-morbidities and frailty have once again been largely excluded and there are no published data on safety and efficacy in this group. Although the speed and impact of the pandemic on older people with frailty justify an approach where they are offered vaccination first, patients and their carers and supervising health care professionals alike will need to make a decision on accepting vaccination based on limited evidence. Here we review the main candidate vaccines that may become available, with a focus on the evidence of safety and efficacy in older people.

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Author and article information

Journal

Journal ID (nlm-ta): Age Ageing

Journal ID (iso-abbrev): Age Ageing

Journal ID (publisher-id): ageing

Title: Age and Ageing

Publisher: Oxford University Press

ISSN (Print): 0002-0729

ISSN (Electronic): 1468-2834

Publication date Collection: May 2022

Publication date (Electronic): 03 May 2022

Publication date PMC-release: 03 May 2022

Volume: 51

Issue: 5

Electronic Location Identifier: afac084

Affiliations

[1 ] Swansea University , Wales, UK

[2 ] Population Data Science, Swansea University , Wales, UK

Author notes

Address correspondence to: Joe Hollinghurst. Email: j.p.hollinghurst@ 123456Swansea.ac.uk

Author information

Joe Hollinghurst https://orcid.org/0000-0002-3556-2017

Rich Fry https://orcid.org/0000-0002-7968-6679

Article

Publisher ID: afac084

DOI: 10.1093/ageing/afac084

PMC ID: 9070807

PubMed ID: 35511729

SO-VID: f1b1d2ee-4739-4efd-829e-8d64bf1bac91

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 15 October 2021

Date revision requested : 8 February 2022

Page count

Pages: 00

Funding

Funded by: funder-nameEconomic and Social Research Council, DOI 10.13039/501100000269;

Award ID: ES/S007393/1

Funded by: funder-nameWellcome Trust, DOI 10.13039/100010269;

Funded by: funder-nameBritish Heart Foundation, DOI 10.13039/501100000274;

Funded by: funder-namePublic Health Agency, DOI 10.13039/501100001626;

Funded by: funder-nameHealth and Social Care Research and Development Division, DOI 10.13039/501100010756;

Funded by: funder-nameChief Scientist Office of the Scottish Government Health and Social Care Directorates;

Funded by: funder-nameDepartment of Health and Social Care, DOI 10.13039/501100000276;

Funded by: funder-nameEconomic and Social Research Council, DOI 10.13039/501100000269;

Funded by: funder-nameEngineering and Physical Sciences Research Council, DOI 10.13039/501100000266;

Funded by: funder-nameUK Medical Research Council, DOI 10.13039/501100000265;

Funded by: funder-nameHealth Data Research UK;

Award ID: HDR-9006

Funded by: funder-nameHealth and Care Research Wales, DOI 10.13039/100012068;

Award ID: Project: SCF-18-1504

Funded by: funder-nameMedical Research Council, DOI 10.13039/501100000265;

Award ID: MR/V028367/1

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COVID-19 risk factors amongst 14,786 care home residents: an observational longitudinal analysis including daily community positive test rates of COVID-19, hospital stays and vaccination status in Wales (UK) between 1 September 2020 and 1 May 2021

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Abstract

Background

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Conclusions

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Novel Coronavirus Disease COVID-19

Most cited references 22

Development and validation of a Hospital Frailty Risk Score focusing on older people in acute care settings using electronic hospital records: an observational study

The SAIL databank: linking multiple health and social care datasets

Efficacy and safety of COVID-19 vaccines in older people

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