Excess mortality for men and women above age 70 according to level of care during the first wave of COVID-19 pandemic in Sweden: A population-based study

BACKGROUND: Both age and comorbidity are established risk factors for death among those infected with COVID-19. Because they often co-exist, it is difficult to assess if age is a risk factor on its own. METHODS: We used administrative register data of the total Swedish population from 01/2015 until 07/2020. We stratified the population aged 70+ into three groups according to level of care (in care homes, with home care, and in independent living). Within these groups, we explored the level of excess mortality in 2020 by estimating expected mortality with Poisson regression and compared it to observed levels. We investigated if excess mortality has been of the same magnitude in the three groups, and if age constitutes a risk factor for death during the pandemic regardless of level of care. FINDINGS: Individuals living in care homes experienced the highest excess mortality (75- >100% in April, 25–50% in May, 0–25% in June, depending on age). Individuals with home care showed the second highest magnitude (30–60% in April, 15–40% in May, 0–25% in June), while individuals in independent living experienced excess primarily at the highest ages (5–50% in April, 5–50% in May, 0–25% in June). Although mortality rates increased, the age-pattern of mortality during the pandemic resembled the age-pattern observed in previous years. INTERPRETATION: We found stepwise elevated excess mortality by level of care during the first wave of the COVID-19 pandemic in Sweden, suggesting that level of frailty or comorbidities plays a more important role than age for COVID-19 associated deaths. Part of our findings are likely attributable to differences in exposure to the virus between individuals receiving formal care and those living independently, and not only different case fatality between the groups. Although age is a strong predictor for mortality, the relative effect of age on mortality was no different during the pandemic than before. We believe this is an important contribution to the discussion of the pandemic, its consequences, and which groups need the most protection. FUNDING: This study was funded by the Swedish Research Council for Health, Working Life and Welfare (FORTE: grant 2016-07115).