Residential context and COVID-19 mortality among the elderly in Stockholm : a population-based, observational study

Abstract

Background: Housing characteristics and neighbourhood context are considered risk factors for COVID-19 mortality among the elderly. This study is the first to examine how individuallevel housing and neighbourhood characteristics are associated with old-age COVID-19 mortality. Methods: We perform Cox proportional hazards regression for the risk of dying from COVID-19 (N=1,299) and from all other causes (N=2,302) in all individuals aged 70 and above living in the Stockholm region (N=274,542). Findings: In fully adjusted models, household and neighbourhood characteristics are independently associated with COVID-19 mortality among the elderly. Compared to living in only-old households, living with someone of working age is associated with elevated COVID-19 mortality (HR = 1.6; 95% CI = 1.3-2.0). Living in a care home is associated with a 4-fold (HR = 4.1; 95% CI = 3.5-4.9) risk of COVID-19 mortality compared to living in independent housing. Living in neighbourhoods with the highest population density was associated with higher COVID-19 mortality (HR = 1.6; 95% CI = 1.1-2.4) compared to living in the least densely populated neighbourhoods. Interpretation: The close exposure to working-age individuals -- be it in the form of care workers, household members, or neighbours -- can have detrimental effects on elderly people’s ability to survive the COVID-19 pandemic. These factors should be taken into account when developing strategies to protect this group. Funding: The Swedish Research Council for Health, Working Life and Welfare (FORTE), grant 2016-07115. The Swedish Foundation for Humanities and Social Sciences (Riksbankens Jubileumsfond), grant M18-0214:1.