Residential context and COVID-19 mortality among adults aged 70 years and older in Stockholm: a population-based, observational study using individual-level data

Summary: Background: Housing characteristics and neighbourhood context are considered risk factors for COVID-19 mortality among older adults. The aim of this study was to investigate how individual-level housing and neighbourhood characteristics are associated with COVID-19 mortality in older adult...

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Main Authors: Maria Brandén, PhD, Siddartha Aradhya, PhD, Martin Kolk, PhD, Juho Härkönen, ProfPhD, Sven Drefahl, PhD, Bo Malmberg, ProfPhD, Mikael Rostila, ProfPhD, Agneta Cederström, PhD, Gunnar Andersson, ProfPhD, Eleonora Mussino, PhD
Format: Article
Language:English
Published: Elsevier 2020-11-01
Series:The Lancet. Healthy Longevity
Online Access:http://www.sciencedirect.com/science/article/pii/S2666756820300167
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author Maria Brandén, PhD
Siddartha Aradhya, PhD
Martin Kolk, PhD
Juho Härkönen, ProfPhD
Sven Drefahl, PhD
Bo Malmberg, ProfPhD
Mikael Rostila, ProfPhD
Agneta Cederström, PhD
Gunnar Andersson, ProfPhD
Eleonora Mussino, PhD
spellingShingle Maria Brandén, PhD
Siddartha Aradhya, PhD
Martin Kolk, PhD
Juho Härkönen, ProfPhD
Sven Drefahl, PhD
Bo Malmberg, ProfPhD
Mikael Rostila, ProfPhD
Agneta Cederström, PhD
Gunnar Andersson, ProfPhD
Eleonora Mussino, PhD
Residential context and COVID-19 mortality among adults aged 70 years and older in Stockholm: a population-based, observational study using individual-level data
The Lancet. Healthy Longevity
author_facet Maria Brandén, PhD
Siddartha Aradhya, PhD
Martin Kolk, PhD
Juho Härkönen, ProfPhD
Sven Drefahl, PhD
Bo Malmberg, ProfPhD
Mikael Rostila, ProfPhD
Agneta Cederström, PhD
Gunnar Andersson, ProfPhD
Eleonora Mussino, PhD
author_sort Maria Brandén, PhD
title Residential context and COVID-19 mortality among adults aged 70 years and older in Stockholm: a population-based, observational study using individual-level data
title_short Residential context and COVID-19 mortality among adults aged 70 years and older in Stockholm: a population-based, observational study using individual-level data
title_full Residential context and COVID-19 mortality among adults aged 70 years and older in Stockholm: a population-based, observational study using individual-level data
title_fullStr Residential context and COVID-19 mortality among adults aged 70 years and older in Stockholm: a population-based, observational study using individual-level data
title_full_unstemmed Residential context and COVID-19 mortality among adults aged 70 years and older in Stockholm: a population-based, observational study using individual-level data
title_sort residential context and covid-19 mortality among adults aged 70 years and older in stockholm: a population-based, observational study using individual-level data
publisher Elsevier
series The Lancet. Healthy Longevity
issn 2666-7568
publishDate 2020-11-01
description Summary: Background: Housing characteristics and neighbourhood context are considered risk factors for COVID-19 mortality among older adults. The aim of this study was to investigate how individual-level housing and neighbourhood characteristics are associated with COVID-19 mortality in older adults. Methods: For this population-based, observational study, we used data from the cause-of-death register held by the Swedish National Board of Health and Welfare to identify recorded COVID-19 mortality and mortality from other causes among individuals (aged ≥70 years) in Stockholm county, Sweden, between March 12 and May 8, 2020. This information was linked to population-register data from December, 2019, including socioeconomic, demographic, and residential characteristics. We ran Cox proportional hazards regressions for the risk of dying from COVID-19 and from all other causes. The independent variables were area (m2) per individual in the household, the age structure of the household, type of housing, confirmed cases of COVID-19 in the borough, and neighbourhood population density. All models were adjusted for individual age, sex, country of birth, income, and education. Findings: Of 279 961 individuals identified to be aged 70 years or older on March 12, 2020, and residing in Stockholm in December, 2019, 274 712 met the eligibility criteria and were included in the study population. Between March 12 and May 8, 2020, 3386 deaths occurred, of which 1301 were reported as COVID-19 deaths. In fully adjusted models, household and neighbourhood characteristics were independently associated with COVID-19 mortality among older adults. Compared with living in a household with individuals aged 66 years or older, living with someone of working age (<66 years) was associated with increased COVID-19 mortality (hazard ratio 1·6; 95% CI 1·3–2·0). Living in a care home was associated with an increased risk of COVID-19 mortality (4·1; 3·5–4·9) compared with living in independent housing. Living in neighbourhoods with the highest population density (≥5000 individuals per km2) was associated with higher COVID-19 mortality (1·7; 1·1–2·4) compared with living in the least densely populated neighbourhoods (0 to <150 individuals per km2). Interpretation: Close exposure to working-age household members and neighbours is associated with increased COVID-19 mortality among older adults. Similarly, living in a care home is associated with increased mortality, potentially through exposure to visitors and care workers, but also due to poor underlying health among care-home residents. These factors should be considered when developing strategies to protect this group. Funding: Swedish Research Council for Health, Working Life and Welfare (FORTE), Swedish Foundation for Humanities and Social Sciences.
url http://www.sciencedirect.com/science/article/pii/S2666756820300167
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spelling doaj-303bd364ec9843dda5697bedeb3aa94f2021-02-27T04:41:27ZengElsevierThe Lancet. Healthy Longevity2666-75682020-11-0112e80e88Residential context and COVID-19 mortality among adults aged 70 years and older in Stockholm: a population-based, observational study using individual-level dataMaria Brandén, PhD0Siddartha Aradhya, PhD1Martin Kolk, PhD2Juho Härkönen, ProfPhD3Sven Drefahl, PhD4Bo Malmberg, ProfPhD5Mikael Rostila, ProfPhD6Agneta Cederström, PhD7Gunnar Andersson, ProfPhD8Eleonora Mussino, PhD9The Institute for Analytical Sociology, Linköping University, Norrköping, Sweden; Demography Unit, Department of Sociology, Stockholm University, Stockholm, Sweden; Correspondence to: Dr Maria Brandén, The Institute for Analytical Sociology, Linköping University, Norrköping 601 74, SwedenDemography Unit, Department of Sociology, Stockholm University, Stockholm, SwedenDemography Unit, Department of Sociology, Stockholm University, Stockholm, Sweden; Institute for Futures Studies, Stockholm, SwedenDemography Unit, Department of Sociology, Stockholm University, Stockholm, Sweden; Department of Political and Social Sciences, European University Institute, San Domenico di Fiesole, ItalyDemography Unit, Department of Sociology, Stockholm University, Stockholm, SwedenDepartment of Human Geography, Stockholm University, Stockholm, SwedenDepartment of Public Health Sciences, Stockholm University, Stockholm, Sweden; Centre for Health Equity Studies, Stockholm University and Karolinska Institutet, Stockholm, SwedenDepartment of Public Health Sciences, Stockholm University, Stockholm, Sweden; Centre for Health Equity Studies, Stockholm University and Karolinska Institutet, Stockholm, SwedenDemography Unit, Department of Sociology, Stockholm University, Stockholm, SwedenDemography Unit, Department of Sociology, Stockholm University, Stockholm, SwedenSummary: Background: Housing characteristics and neighbourhood context are considered risk factors for COVID-19 mortality among older adults. The aim of this study was to investigate how individual-level housing and neighbourhood characteristics are associated with COVID-19 mortality in older adults. Methods: For this population-based, observational study, we used data from the cause-of-death register held by the Swedish National Board of Health and Welfare to identify recorded COVID-19 mortality and mortality from other causes among individuals (aged ≥70 years) in Stockholm county, Sweden, between March 12 and May 8, 2020. This information was linked to population-register data from December, 2019, including socioeconomic, demographic, and residential characteristics. We ran Cox proportional hazards regressions for the risk of dying from COVID-19 and from all other causes. The independent variables were area (m2) per individual in the household, the age structure of the household, type of housing, confirmed cases of COVID-19 in the borough, and neighbourhood population density. All models were adjusted for individual age, sex, country of birth, income, and education. Findings: Of 279 961 individuals identified to be aged 70 years or older on March 12, 2020, and residing in Stockholm in December, 2019, 274 712 met the eligibility criteria and were included in the study population. Between March 12 and May 8, 2020, 3386 deaths occurred, of which 1301 were reported as COVID-19 deaths. In fully adjusted models, household and neighbourhood characteristics were independently associated with COVID-19 mortality among older adults. Compared with living in a household with individuals aged 66 years or older, living with someone of working age (<66 years) was associated with increased COVID-19 mortality (hazard ratio 1·6; 95% CI 1·3–2·0). Living in a care home was associated with an increased risk of COVID-19 mortality (4·1; 3·5–4·9) compared with living in independent housing. Living in neighbourhoods with the highest population density (≥5000 individuals per km2) was associated with higher COVID-19 mortality (1·7; 1·1–2·4) compared with living in the least densely populated neighbourhoods (0 to <150 individuals per km2). Interpretation: Close exposure to working-age household members and neighbours is associated with increased COVID-19 mortality among older adults. Similarly, living in a care home is associated with increased mortality, potentially through exposure to visitors and care workers, but also due to poor underlying health among care-home residents. These factors should be considered when developing strategies to protect this group. Funding: Swedish Research Council for Health, Working Life and Welfare (FORTE), Swedish Foundation for Humanities and Social Sciences.http://www.sciencedirect.com/science/article/pii/S2666756820300167