Butfield Rebecca, Bray Benjamin, Quint Jennifer K, Castanon Alejandra, Adesanya Elizabeth, Chen Simon, Russell Rachel
Pfizer Ltd, Sandwich, UK
Lane Clark & Peacock LLP, London, UK.
BMJ Open. 2025 Jul 21;15(7):e100534. doi: 10.1136/bmjopen-2025-100534.
To estimate the impact of COVID-19 infection on the requirement for social care services among adults aged ≥50 years in North-West London.
Population-based matched cohort study using linked routinely collected electronic social care, primary care and hospital records (the Discover dataset).
Approximately 4.7 million people with a general practitioner record in North-West London.
150 654 adults aged ≥50 years with a first diagnosis of COVID-19 between January 2020 and February 2023 and 547 704 propensity score matched comparators without a COVID-19 diagnosis during the same period.
Social care use and associated costs overall and by specific type (care home, domiciliary care, respite care, social care assessments) stratified by age group, index year, diagnosis setting, severe COVID-19 risk status, frailty and care home admission prior to index. Overall survival was also assessed.
A total of 9174 (6.09%) individuals with COVID-19 required social care use (of any type) during follow-up, 2.54 times (95% CI 2.48 to 2.61; p<0.0001) higher than matched comparators (n=13 126, 2.40%). The difference was largest for care home admission; individuals with COVID-19 had 4.10 (95% CI 3.87 to 4.36; p<0.0001) times the risk of a care home admission and nearly twice the risk (risk ratio 1.94; 95% CI 1.86 to 2.02; p<0.0001) of domiciliary care during follow-up compared with matched comparators. Individuals with COVID-19 experienced higher mortality, with 9.30% (14 005/547 704) dying during follow-up compared with 3.76% (20 608/547 704) deaths among matched comparators.This increase in social care utilisation was observed for all age groups. Adults with COVID-19 had over four times higher social care costs than matched comparators (£1276 per person per year (pppy) vs £276 pppy; mean difference +£1000, 95% CI £947 to £1054, p<0.0001), with most of the costs due to care home admissions. Higher social care costs in individuals with COVID-19 compared with matched comparators were strongly age related, rising from a mean difference of £130 pppy (95% CI £99 to £161) in those aged 50-64 to £6108 pppy (95% CI £5613 to £6603) higher costs in those aged ≥85.
COVID-19 infection is associated with meaningfully higher social care requirements in the ≥50 years population. Reducing the need for social care use and the associated costs of care should be one of the goals of interventions to reduce the risk and severity of COVID-19 infection.
评估2019冠状病毒病（COVID-19）感染对伦敦西北部50岁及以上成年人社会护理服务需求的影响。
基于人群的匹配队列研究，使用常规收集的电子社会护理、初级护理和医院记录相链接的数据（发现数据集）。
伦敦西北部约有470万人有全科医生记录。
2020年1月至2023年2月期间首次诊断为COVID-19的150654名50岁及以上成年人，以及547704名倾向评分匹配的同期未诊断为COVID-19的对照者。
按年龄组、索引年份、诊断地点、重症COVID-19风险状态、虚弱程度和索引前入住养老院情况分层的社会护理使用情况及相关费用，包括总体费用和特定类型（养老院护理、居家护理、临时护理、社会护理评估）的费用。还评估了总生存率。
共有9174名（6.09%）COVID-19患者在随访期间需要使用社会护理服务（任何类型），是匹配对照者（n = 13126，2.40%）的2.54倍（95%CI 2.48至2.61；p<0.0001）。养老院入住差异最大；COVID-19患者入住养老院的风险是匹配对照者的4.10倍（95%CI 3.87至4.36；p<0.0001），随访期间接受居家护理的风险几乎是对照者的两倍（风险比1.94；95%CI 1.86至2.02；p<0.0001）。COVID-19患者的死亡率更高，随访期间死亡率为9.30%（14005/547704），而匹配对照者的死亡率为3.76%（20608/547704）。所有年龄组均观察到社会护理利用率的这种增加。COVID-19患者的社会护理费用比匹配对照者高出四倍多（每人每年1276英镑 vs 276英镑；平均差异+1000英镑；平均差异+1000英镑，95%CI 947至1054英镑，p<0.0001），大部分费用归因于养老院入住。与匹配对照者相比，COVID-19患者较高的社会护理费用与年龄密切相关，从50-64岁人群的平均差异130英镑（95%CI 99至161英镑）上升到85岁及以上人群的6108英镑（95%CI 5613至6603英镑）。
COVID-19感染与50岁及以上人群中显著更高的社会护理需求相关。减少社会护理使用需求及相关护理费用应成为降低COVID-19感染风险和严重程度干预措施的目标之一。
