key: cord-0967275-y1iy28bl authors: Canoui-Poitrine, F.; Rachas, A.; Thomas, M.; Carcaillon-Bentata, L.; Fontaine, R.; Gavazzi, G.; Laurent, M.; Robine, J.-M. title: Magnitude, change over time, demographic characteristics and geographic distribution of excess deaths among nursing home residents during the first wave of COVID-19 in France: a nationwide cohort study date: 2021-01-14 journal: nan DOI: 10.1101/2021.01.09.20248472 sha: d1ade31f4f227fe6f50824a3f8786e3dd1dd7b35 doc_id: 967275 cord_uid: y1iy28bl Importance: Nursing home (NH) residents are particularly vulnerable to SARS-CoV-2 infections and coronavirus disease 2019 (COVID-19) lethality. However, excess deaths in this population have rarely been documented. Objectives: The primary objective was to assess the number of excess deaths among NH residents during the first wave of the COVID-19 pandemic in France. The secondary objectives were to determine the number of excess deaths as a proportion of the total excess deaths in the general population and determine whether a harvesting effect was present. Design: We studied a cohort of 494,753 adults (as of March 1st, 2020) aged 60 and over in 6,515 NHs in mainland France. This cohort was exposed to the first wave of the COVID-19 pandemic (from March 1st to May 31st, 2020) and was compared with the corresponding, reference cohorts from 2014 to 2019 (using data from the French National Health Data System). Main outcome and measures: The main outcome was all-cause death. Weekly excess deaths and standardized mortality ratios (SMRs) were estimated. Result: There were 13,505 excess deaths among NH residents. Mortality increased by 43% (SMR: 1.43). The mortality excess was higher among males than among females (SMR: 1.51 and 1.38, respectively) and decreased with age (SMRs in females: 1.61 in the 60-74 age group, 1.58 for 75-84, 1.41 for 85-94, and 1.31 for 95 or over; Males: SMRs: 1.59 for 60-74, 1.69 for 75-84, 1.47 for 85-94, and 1.41 for 95 or over). We did not observe a harvesting effect (up until August 30th, 2020). By extrapolating to all NH residents nationally (N=570,003), the latter accounted for 51% of the total excess deaths in the general population (N=15,114 out of 29,563). Conclusion: NH residents accounted for about half of the total excess deaths in France during the first wave of the COVID-19 pandemic. The excess death rate was higher among males than females and among younger residents than among older residents. We did not observe a harvesting effect. A real-time mortality surveillance system and the identification of individual and environmental risk factors might help to design the future model of care for older dependent adults. . T h e m o r t a l i t y e x c e s s w a s h i g h e r a m o n g m a l e s t h a n a m o n g f e m a l e s ( S M R : 1 . 5 1 a n d 1 . 3 8 , r e s p e c t i v e l y ) a n d d e c r e a s e d w i t h a g e ( S M R s i n f e m a l e s : 1 . 6 1 i n t h e 6 0 -7 4 a g e g r o u p , 1 . 5 8 f o r 7 5 -8 4 , 1 . 4 1 f o r 8 5 -9 4 , a n d 1 . 3 1 f o r 9 5 o r o v e r ; M a l e s : S M R s : 1 . 5 9 f o r 6 0 -7 4 , 1 . 6 9 f o r 7 5 -8 4 , 1 . 4 7 f o r 8 5 -9 4 , a n d 1 . 4 1 f o r 9 5 o r o v e r ) . W e d i d n o t o b s e r v e a h a r v e s t i n g e f f e c t ( u p u n t i l A u g u s t 3 0 t h , 2 0 2 0 ) . B y e x t r a p o l a t i n g t o a l l N H r e s i d e n t s n a t i o n a l l y ( N = 5 7 0 , 0 0 3 ) , t h e l a t t e r a c c o u n t e d f o r 5 1 % o f t h e t o t a l e x c e s s d e a t h s i n t h e g e n e r a l p o p u l a t i o n ( N = 1 5 , 1 1 4 o u t o f 2 9 , 5 6 3 ) . C o n c l u s i o n : N H r e s i d e n t s a c c o u n t e d f o r a b o u t h a l f o f t h e t o t a l e x c e s s d e a t h s i n F r a n c e d u r i n g t h e f i r s t w a v e o f t h e C O V I D -1 9 p a n d e m i c . T h e e x c e s s d e a t h r a t e w a s h i g h e r a m o n g m a l e s t h a n f e m a l e s a n d a m o n g y o u n g e r r e s i d e n t s t h a n a m o n g o l d e r r e s i d e n t s . W e d i d n o t o b s e r v e a h a r v e s t i n g e f f e c t . A r e a l -t i m e m o r t a l i t y s u r v e i l l a n c e s y s t e m a n d t h e i d e n t i f i c a t i o n o f i n d i v i d u a l a n d e n v i r o n m e n t a l r i s k f a c t o r s m i g h t h e l p t o d e s i g n t h e f u t u r e m o d e l o f c a r e f o r o l d e r d e p e n d e n t a d u l t s . 3 5 0 w o r d s K e y -w o r d s : C O V I D -1 9 / E x c e s s d e a t h s / E l d e r l y a d u l t s / N u r s i n g h o m e K e y p o i n t s : • D u r i n g t h e f i r s t w a v e o f t h e C O V I D -1 9 p a n d e m i c i n F r a n c e , t h e m o r t a l i t y a m o n g n u r s i n g h o m e r e s i d e n t s i n c r e a s e d b y 4 3 % . • N u r s i n g h o m e r e s i d e n t s a c c o u n t e d f o r 5 1 % o f t h e t o t a l e x c e s s d e a t h s i n F r a n c e . • T h e e x c e s s m o r t a l i t y w a s h i g h e r a m o n g y o u n g e r r e s i d e n t s t h a n a m o n g o l d e All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. I n t r o d u c t i o n I n h i g h -i n c o m e c o u n t r i e s , a l m o s t a l l d e a t h s c a u s e b y c o r o n a v i r u s d i s e a s e 2 0 1 9 ( C O V I D -1 9 ) h a v e o c c u r r e d i n o l d e r a d u l t s . I n t h e U n i t e d S t a t e s , 8 0 % o f t h e d e a t h s o c c u r r e d a m o n g p e o p l e a g e d 6 5 o r o v e r ) w a s p r e s e n t . All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. p r o v i d e d b y t h e F r e n c h N a t i o n a l S t a t i s t i c s O f f i c e ( I n s t i t u t N a t i o n a l d e l a S t a t i s t i q u e e t d e s E t u d e s E c o n o m i q u e s , I N S E E ) t h r o u g h l o c a l h e a l t h i n s u r a n c e o f f i c e s . T h e s t a n d a r d , a n o n y m i z e d S N D S d a t a e x t r a c t s m a d e a v a i l a b l e t o a u t h o r i z e d r e s e a r c h e r s d o n o t c o n t a i n t r e 9 6 i n m a i n l a n d F r a n c e ) . (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. o f m i s s i n g N H r e s i d e n t s w e r e o b t a i n e d f r o m t h e F r e n c h n a t i o n a l r e g i s t r y o f h e a l t h c a r e a n d s o c i a l e s t a b l i s h m e n t s ( F i c h i e r n a t i o n a l d e s é t a b l i s s e m e n t s s a n i t a i r e s e t s o c i a u x , F I N E S S ) a s o f M a r c h 2 9 t h , 2 0 2 0 . W e t h e n c o m p u t e d e x c e s s d e a t h s a m o n g N H r e s i d e n t s a s a p r o p o r All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. T h e c h a n g e s o v e r t i m e w e r e s i m i l a r i n t h e f o u r a g e g r o u p s a n d i n b o t h s e x e s ( F i g u r e 3 ) . T h e e x c e s s m o r t a l i t y r a t e w a s h i g h e r a m o n g m a l e s t h a n a m o n g f e m a l e s ( T a b l e 2 ) a n d d e c r e a s e d w i t h a g e i n f e m a l e s ( T a b l e 2 a n d F i g u r e 2 ) . I n m a l e s , t h e S M R w a s h i g h e r i n t h e 7 5 -8 ) . All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. A All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 14, 2021 . l a c k o f P C R t e s t s a t t h e b e g i n n i n g o f t h e p a n d e m i c , a t y p i c a l c l i n i c a l p r e s e n t a t i o n s i n o l d e r p e o p l e , r e p o r t s o f b o t h s u s p e c t e d a n d c o n f i r m e d c a s e s t o t h e h e a l t h s u r v e i l l a n c e s y s t e m , a n d ( i n F r a n c e ) e r r o n e o u s r e p o r t i n g o f t h e p l a c e o f d e a t h b y m u n i c i p a l o f f i c e s o f v i t a l r e c o (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. t h o s e w h o s e h e a l t h w a s a l r e a d y s o c o m p r o m i s e d t h a t t h e y " w o u l d h a v e d i e d i n t h e s h o r t t e r m a n y w a y " b u t a l s o c o m p r o m i s e d t h e h e a l t h o f t h e s u r v i v o r s . A n o t h e r e x p l a n a t i o n m i g h t b e t h e p e r s i s t e n c e o f C O V I D -1 9 u n t i l A u g u s t -t h e v e r y b e g i n n i n g o f t h e s e c o n d w a v e . L a s t l y , (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. 2 0 2 0 ' s e x c e s s d e a t h s w i t h e a c h s i n g l e r e f e r e n c e y e a r a s a f u n c t i o n o f t h e i n f l u e n z a e p i d e m i All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. R e f e r e n c e s T a b l e 1 : B a s e l i n e c h a r a c t e r i s t i c s o f t h e r e s i d e n t s a n d t h e N H s V a r i a b l e I t e m R e s i d e n t s F e m a l e s M a l e s S e x 3 6 8 , 1 6 5 ( 7 4 ) M o r t a l i t y d u r i n g t h e f i r s t w a v e a o f t h e C O V I D -1 9 e p i d e m i c i n F r a n c e , b y s e x a n d b y a g e g r o u p s e x a g e g r o u p ( y e a r s ) n u m b e r o f r e s i d e n t s n u m b e r o f d e a t h s c u m u l a t i v e m o r t a l i t y r a t e ( % ) b n u m b e r o f e x c e s s d e a t h s S M R c b o t h a l l 4 9 4 7 5 3 4 4 6 6 6 9 . 5 1 3 , 5 0 All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. 3 4 5 6 7 8 9 1 0 1 1 1 2 1 3 1 4 1 5 1 6 1 7 1 8 1 9 2 0 2 1 2 2 2 3 2 4 2 5 2 6 2 7 2 8 2 9 3 0 3 1 3 2 3 3 3 4 (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. 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