biostudies-literatureDutey-Magni PFEconomic and Social Research CouncilBritish Heart FoundationHealth and Social Care Research and Development DivisionDepartment of Health and Human ServicesPublic Health AgencyEngineering and Physical Sciences Research CouncilHealth Data Research UKHHSIn-Practice fellowshipNational Institute for Health ResearchNational Institute on Handicapped ResearchScottish Government Health and Social Care DirectorateMedical Research CouncilWellcome TrustInnovative Medicines Initiative-2 Joint Undertaking1019-1028https://www.ebi.ac.uk/biostudies/studies/S-EPMC7989651biostudies-literatureUnknown50(4)<h4>Background</h4>epidemiological data on COVID-19 infection in care homes are scarce. We analysed data from a large provider of long-term care for older people to investigate infection and mortality during the first wave of the pandemic.<h4>Methods</h4>cohort study of 179 UK care homes with 9,339 residents and 11,604 staff. We used manager-reported daily tallies to estimate the incidence of suspected and confirmed infection and mortality in staff and residents. Individual-level electronic health records from 8,713 residents were used to model risk factors for confirmed infection, mortality and estimate attributable mortality.<h4>Results</h4>2,075/9,339 residents developed COVID-19 symptoms (22.2% [95% confidence interval: 21.4%; 23.1%]), while 951 residents (10.2% [9.6%; 10.8%]) and 585 staff (5.0% [4.7%; 5.5%]) had laboratory-confirmed infections. The incidence of confirmed infection was 152.6 [143.1; 162.6] and 62.3 [57.3; 67.5] per 100,000 person-days in residents and staff, respectively. Sixty-eight percent (121/179) of care homes had at least one COVID-19 infection or COVID-19-related death. Lower staffing ratios and higher occupancy rates were independent risk factors for infection.Out of 607 residents with confirmed infection, 217 died (case fatality rate: 35.7% [31.9%; 39.7%]). Mortality in residents with no direct evidence of infection was twofold higher in care homes with outbreaks versus those without (adjusted hazard ratio: 2.2 [1.8; 2.6]).<h4>Conclusions</h4>findings suggest many deaths occurred in people who were infected with COVID-19, but not tested. Higher occupancy and lower staffing levels were independently associated with risks of infection. Protecting staff and residents from infection requires regular testing for COVID-19 and fundamental changes to staffing and care home occupancy.Age and ageingCOVID-19 infection and attributable mortality in UK care homes: cohort study using active surveillance and electronic records (March-June 2020).PMC7989651ES/V003887/1NIHR300293CS-2016-007LOND1116074Hemingway HRait GDutey-Magni PFWilliams HJhass AShallcross LLorencatto FHayward AfalseCOVID-19 infection and attributable mortality in UK care homes: cohort study using active surveillance and electronic records (March-June 2020).<h4>Background</h4>epidemiological data on COVID-19 infection in care homes are scarce. We analysed data from a large provider of long-term care for older people to investigate infection and mortality during the first wave of the pandemic.<h4>Methods</h4>cohort study of 179 UK care homes with 9,339 residents and 11,604 staff. We used manager-reported daily tallies to estimate the incidence of suspected and confirmed infection and mortality in staff and residents. Individual-level electronic health records from 8,713 residents were used to model risk factors for confirmed infection, mortality and estimate attributable mortality.<h4>Results</h4>2,075/9,339 residents developed COVID-19 symptoms (22.2% [95% confidence interval: 21.4%; 23.1%]), while 951 residents (10.2% [9.6%; 10.8%]) and 585 staff (5.0% [4.7%; 5.5%]) had laboratory-confirmed infections. The incidence of confirmed infection was 152.6 [143.1; 162.6] and 62.3 [57.3; 67.5] per 100,000 person-days in residents and staff, respectively. Sixty-eight percent (121/179) of care homes had at least one COVID-19 infection or COVID-19-related death. Lower staffing ratios and higher occupancy rates were independent risk factors for infection.Out of 607 residents with confirmed infection, 217 died (case fatality rate: 35.7% [31.9%; 39.7%]). Mortality in residents with no direct evidence of infection was twofold higher in care homes with outbreaks versus those without (adjusted hazard ratio: 2.2 [1.8; 2.6]).<h4>Conclusions</h4>findings suggest many deaths occurred in people who were infected with COVID-19, but not tested. Higher occupancy and lower staffing levels were independently associated with risks of infection. Protecting staff and residents from infection requires regular testing for COVID-19 and fundamental changes to staffing and care home occupancy.2021-01-01T00:00:00Z2021 Jun2022-02-11T12:17:33.629Z2022-02-11T12:17:33.629ZS-EPMC79896513371028110.1093/ageing/afab060