The association between frailty, long-term care home characteristics and COVID-19 mortality before and after SARS-CoV-2 vaccination: a retrospective cohort study

• Published in: Age and ageing Vol. 52; no. 12
• Main Authors: Dash, Darly, Mowbray, Fabrice I, Poss, Jeffrey W, Aryal, Komal, Stall, Nathan M, Hirdes, John P, Hillmer, Michael P, Heckman, George A, Bowdish, Dawn M E, Costa, Andrew P, Jones, Aaron
• Format: Journal Article
• Language: English
• Published: England 01.12.2023
• Subjects: COVID-19 - prevention & control; COVID-19 Vaccines; Frailty; Humans; Long-Term Care; Male; Ontario - epidemiology; Retrospective Studies; SARS-CoV-2; Vaccination; Ontario; COVID-19; older adults; frailty; long-term care homes; older people; multi-level models
• ISSN: 0002-0729; 1468-2834; 1468-2834
• DOI: 10.1093/ageing/afad229

The relative contributions of long-term care (LTC) resident frailty and home-level characteristics on COVID-19 mortality has not been well studied. We examined the association between resident frailty and home-level characteristics with 30-day COVID-19 mortality before and after the availability of SARS-CoV-2 vaccination in LTC. We conducted a population-based retrospective cohort study of LTC residents with confirmed SARS-CoV-2 infection in Ontario, Canada. We used multi-level multivariable logistic regression to examine associations between 30-day COVID-19 mortality, the Hubbard Frailty Index (FI), and resident and home-level characteristics. We compared explanatory models before and after vaccine availability. There were 11,179 and 3,655 COVID-19 cases in the pre- and post-vaccine period, respectively. The 30-day COVID-19 mortality was 25.9 and 20.0% during the same periods. The median odds ratios for 30-day COVID-19 mortality between LTC homes were 1.50 (95% credible interval [CrI]: 1.41-1.65) and 1.62 (95% CrI: 1.46-1.96), respectively. In the pre-vaccine period, 30-day COVID-19 mortality was higher for males and those of greater age. For every 0.1 increase in the Hubbard FI, the odds of death were 1.49 (95% CI: 1.42-1.56) times higher. The association between frailty and mortality remained consistent in the post-vaccine period, but sex and age were partly attenuated. Despite the substantial home-level variation, no home-level characteristic examined was significantly associated with 30-day COVID-19 mortality during either period. Frailty is consistently associated with COVID-19 mortality before and after the availability of SARS-CoV-2 vaccination. Home-level characteristics previously attributed to COVID-19 outcomes do not explain significant home-to-home variation in COVID-19 mortality.