Severe COVID-19 in people 55 and older during the first year of the pandemic in Sweden
Journal article, 2022
Background
Exposure to many contacts is the main risk factor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, while risk of serious disease and death is chiefly determined by old age and comorbidities. Relative and population-attributable fractions (PAFs) of multiple medical and social exposures for COVID-19 outcomes have not been evaluated among older adults.
Objectives
We describe the effect of multiple exposures on the odds of testing positive for the virus and of severe disease (hospital care or death) and PAFs in Swedish citizens aged 55 years and above.
Methods
We used national registers to follow all citizens aged 55 years and above with respect to (1) testing positive, (2) hospitalization, and (3) death between 31 January 2020 and 1 February 2021.
Results
Of 3,410,241 persons, 156,017 (4.6%, mean age 68.3 years) tested positive for SARS-CoV-2, while 35,999 (1.1%, mean age 76.7 years) were hospitalized or died (12,384 deaths, 0.4%, mean age 84.0 years). Among the total cohort, the proportion living without home care or long-term care was 98.8% among persons aged 55–64 and 22.1% of those aged 95 and above. After multiple adjustment, home care and long-term care were associated with odds ratios of 7.9 (95% confidence interval [CI] 6.8–9.1) and 22.5 (95% CI 19.6–25.7) for mortality, with PAFs of 21.9% (95% CI 20.9–22.9) and 33.3% (95% CI 32.4–34.3), respectively.
Conclusion
Among Swedish residents aged 55 years and above, those with home care or long-term care had markedly increased risk for COVID-19 death during the first year of the pandemic, with over 50% of deaths attributable to these factors.
Exposure to many contacts is the main risk factor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, while risk of serious disease and death is chiefly determined by old age and comorbidities. Relative and population-attributable fractions (PAFs) of multiple medical and social exposures for COVID-19 outcomes have not been evaluated among older adults.
Objectives
We describe the effect of multiple exposures on the odds of testing positive for the virus and of severe disease (hospital care or death) and PAFs in Swedish citizens aged 55 years and above.
Methods
We used national registers to follow all citizens aged 55 years and above with respect to (1) testing positive, (2) hospitalization, and (3) death between 31 January 2020 and 1 February 2021.
Results
Of 3,410,241 persons, 156,017 (4.6%, mean age 68.3 years) tested positive for SARS-CoV-2, while 35,999 (1.1%, mean age 76.7 years) were hospitalized or died (12,384 deaths, 0.4%, mean age 84.0 years). Among the total cohort, the proportion living without home care or long-term care was 98.8% among persons aged 55–64 and 22.1% of those aged 95 and above. After multiple adjustment, home care and long-term care were associated with odds ratios of 7.9 (95% confidence interval [CI] 6.8–9.1) and 22.5 (95% CI 19.6–25.7) for mortality, with PAFs of 21.9% (95% CI 20.9–22.9) and 33.3% (95% CI 32.4–34.3), respectively.
Conclusion
Among Swedish residents aged 55 years and above, those with home care or long-term care had markedly increased risk for COVID-19 death during the first year of the pandemic, with over 50% of deaths attributable to these factors.
Author
Annika Rosengren
University of Gothenburg
Christina E. Lundberg
University of Gothenburg
Mia Söderberg
University of Gothenburg
Ailiana Santosa
University of Gothenburg
Jon Edqvist
University of Gothenburg
Martin Lindgren
University of Gothenburg
Maria Åberg
Region Västra Götaland
University of Gothenburg
Magnus Gisslen
Sahlgrenska University Hospital
University of Gothenburg
Josefina Robertson
University of Gothenburg
Sahlgrenska University Hospital
Ottmar Cronie
Chalmers, Mathematical Sciences, Applied Mathematics and Statistics
University of Gothenburg
Naveed Sattar
University of Gothenburg
University of Glasgow
Jesper Lagergren
King's College London
Karolinska University Hospital
Maria Brandén
Linköping University
Stockholm University
Jonas Björk
Lund University
Skåne University Hospital
Martin Adiels
University of Gothenburg
Journal of Internal Medicine, Supplement
0955-7873 (ISSN)
Vol. 292 4 641-653Subject Categories
Public Health, Global Health, Social Medicine and Epidemiology
DOI
10.1111/joim.13522