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...
Main Authors: | , , , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Elsevier
2020-11-01
|
Series: | The Lancet. Healthy Longevity |
Online Access: | http://www.sciencedirect.com/science/article/pii/S2666756820300167 |
id |
doaj-303bd364ec9843dda5697bedeb3aa94f |
---|---|
record_format |
Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
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 |
work_keys_str_mv |
AT mariabrandenphd residentialcontextandcovid19mortalityamongadultsaged70yearsandolderinstockholmapopulationbasedobservationalstudyusingindividualleveldata AT siddarthaaradhyaphd residentialcontextandcovid19mortalityamongadultsaged70yearsandolderinstockholmapopulationbasedobservationalstudyusingindividualleveldata AT martinkolkphd residentialcontextandcovid19mortalityamongadultsaged70yearsandolderinstockholmapopulationbasedobservationalstudyusingindividualleveldata AT juhoharkonenprofphd residentialcontextandcovid19mortalityamongadultsaged70yearsandolderinstockholmapopulationbasedobservationalstudyusingindividualleveldata AT svendrefahlphd residentialcontextandcovid19mortalityamongadultsaged70yearsandolderinstockholmapopulationbasedobservationalstudyusingindividualleveldata AT bomalmbergprofphd residentialcontextandcovid19mortalityamongadultsaged70yearsandolderinstockholmapopulationbasedobservationalstudyusingindividualleveldata AT mikaelrostilaprofphd residentialcontextandcovid19mortalityamongadultsaged70yearsandolderinstockholmapopulationbasedobservationalstudyusingindividualleveldata AT agnetacederstromphd residentialcontextandcovid19mortalityamongadultsaged70yearsandolderinstockholmapopulationbasedobservationalstudyusingindividualleveldata AT gunnaranderssonprofphd residentialcontextandcovid19mortalityamongadultsaged70yearsandolderinstockholmapopulationbasedobservationalstudyusingindividualleveldata AT eleonoramussinophd residentialcontextandcovid19mortalityamongadultsaged70yearsandolderinstockholmapopulationbasedobservationalstudyusingindividualleveldata |
_version_ |
1724248242203394048 |
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 |