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Case–control study to estimate odds of death within 28 days of positive test for SARS-CoV-2 prior to vaccination for residents of long-term care facilities in England, 2020–2021
  1. Karthik Paranthaman1,
  2. Hester Allen2,
  3. Dimple Chudasama2,
  4. Neville Q Verlander3,
  5. James Sedgwick1
  1. 1 Field Service, UK Health Security Agency, London, UK
  2. 2 COVID-19 Epidemiology Cell, UK Health Security Agency, London, UK
  3. 3 Statistics, Modelling and Economics Department, UK Health Security Agency, London, UK
  1. Correspondence to Dr Karthik Paranthaman, Field Service, UK Health Security Agency, London, UK; Karthik.Paranthaman{at}


Background Persons living in long-term care facilities (LTCFs) are presumed to be at higher risk of adverse outcomes from SARS-CoV-2 infection due to increasing age and frailty, but the magnitude of increased risk is not well quantified.

Methods After linking demographic and mortality data for cases with confirmed SARS-CoV-2 infection between March 2020 and January 2021 in England, a random sample of 6000 persons who died and 36 000 who did not die within 28 days of a positive test was obtained from the dataset of 3 020 800 patients. Based on an address-matching process, the residence type of each case was categorised into one of private home and residential or nursing LTCF. Univariable and multivariable logistic regression analysis was conducted.

Results Multivariable analysis showed that an interaction effect between age and residence type determined the outcome. Compared with a 60-year-old person not living in LTCF, the adjusted OR (aOR) for same-aged persons living in residential and nursing LTCFs was 1.77 (95% CI 1.21 to 2.6, p=0.0017) and 3.95 (95% CI 2.77 to 5.64, p<0.0001), respectively. At 90 years of age, aORs were 0.87 (95% CI 0.72 to 1.06, p=0.21) and 0.74 (95% CI 0.61 to 0.9, p=0.001), respectively. The model had an overall accuracy of 94.2% (94.2%) when applied to the full dataset of 2 978 800 patients.

Conclusion This study found that residents of LTCFs in England had higher odds of death up to 80 years of age. Beyond 80 years, there was no difference in the odds of death for LTCF residents compared with those in the wider community.

  • COVID-19
  • epidemiology
  • ageing

Data availability statement

No data are available. We are unable to share data due to legal considerations.

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Data availability statement

No data are available. We are unable to share data due to legal considerations.

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  • Contributors KP and NQV designed the study. HA and DC led on the address matching process and linking datasets. KP analysed the data and wrote the first draft of the manuscript. All authors reviewed and contributed to the content of the manuscript. KP is the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.