key: cord-0843839-379lh456
authors: Savage, Rachel D.; Rochon, Paula A.; Na, Yingbo; Strauss, Rachel; Brown, Kevin A.; Costa, Andrew P.; Gill, Sudeep; Johnstone, Jennie; Tanuseputro, Peter; Stall, Nathan M.; Armstrong, Pat
title: Excess mortality in long-term care residents with and without personal contact with family or friends during the COVID-19 pandemic
date: 2021-12-18
journal: J Am Med Dir Assoc
DOI: 10.1016/j.jamda.2021.12.015
sha: d2386b1dbfbe469ff0464e50dd037032260b3f7e
doc_id: 843839
cord_uid: 379lh456

Early in the pandemic in Ontario, Canada, long-term care residents without contact with family or friends experienced disproportionate impacts of COVID-19, with 35% greater excess mortality than residents with personal contact with family or friends.

Funding source: This study was supported by ICES, which is funded by an annual grant from the Tables: 1 table   48   49 Brief summary: Early in the pandemic in Ontario, Canada, long-term care residents without 50 contact with family or friends experienced disproportionate impacts of COVID-19, with 35% 51 greater excess mortality than residents with personal contact with family or friends.

Despite evidence of disparities in excess mortality during the COVID-19 pandemic 1 , less is 5 known about the unequal impacts within long-term care (LTC). 2 Even pre-pandemic, many 6 residents experienced loneliness and social isolation. 3 The most isolatedthose without living 7 family or friends, or who are geographically distant or estranged from them 4often receive 8 increased care and support from LTC staff. 5 With the demands of COVID-19, these efforts may 9 not have been possible to sustain. This may have led already socially vulnerable residents to be 10 disproportionately affected by COVID-19, especially without family/friends to advocate for 11 needed care or provide emotional support. Our objective was to compare excess mortality early 12 in the COVID-19 pandemic in LTC residents with and without personal contact with family or 13 friends.

14 15

We conducted an interrupted time series (ITS) analysis to evaluate changes in all-cause mortality 17 rates of LTC residents with and without contact with family or friends in Ontario, Canada from "yes" to item F2E (absence of personal contact with family or friends), based on their most 24 recent annual assessment from the Resident Assessment Instrument Minimum Dataset (Version 25 2.0). 6 Item F2E is a reliable measure of family/friend contact. We found 93.5% percent 26 agreement across annual assessments over a five-year lookback window and 95.8% agreement 27 between the last two assessments (Supplementary Table 1 April-September) as explanatory variables.

Excess mortality in the pandemic period was calculated in each group as absolute and relative 40 differences in observed and expected mortality, based on pre-COVID-19 trends. We calculated 41 the difference in excess mortality in residents with and without family or friend contact using a 42 difference-in-differences analysis. Resident characteristics were compared using standardized 43 differences (SD); differences >0.10 were considered meaningful. 7 Data use was authorized under 

During the pandemic period, there was a 57.8% relative increase (absolute change, 12.6 excess 56 deaths per 1,000) in mortality in residents without family or friend contact and a 17.1% increase 57 (4.8 deaths per 1,000) in residents with family or friend contact, representing 34.8% greater 58 excess mortality in residents without personal contact with family or friends (difference-in-59 difference, 7.8 deaths per 1,000) ( Table 1) . Patterns were consistent across sexes and in residents 60 ≥85 years (data not shown). Excess mortality was highest in April, returning to pre-COVID-19 61 levels by June/July when community transmission was low. Overall, 9.5% (54/567) of deaths 62 occurred in residents without family or friend contact with confirmed COVID-19 compared to *. As of March 1, 2020, 77,291 residents lived in Ontario's 623 licensed LTC homes, where they received personal and nursing care, subsidized accommodations, and prescription medications through a publicly funded program. At the start of the pandemic period (March 14, 2020), 67,589 Ontario nursing home residents were alive and had an annual Resident Assessment Instrument Minimum Dataset (RAI-MDS) assessment -66,039 had personal contact with family/friends, 1,550 had no contact.

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