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Association between household composition and severe COVID-19 outcomes in older people by ethnicity

This paper aims to quantify the association between household composition and risk of severe COVID-19 by ethnicity for older individuals

International Journal of Epidemiology, 2022

Abstract

Background

Ethnic differences in the risk of severe COVID-19 may be linked to household composition. We quantified the association between household composition and risk of severe COVID-19 by ethnicity for older individuals.

Methods

With the approval of NHS England, we analysed ethnic differences in the association between household composition and severe COVID-19 in people aged 67 or over in England. We defined households by number of age-based generations living together, and used multivariable Cox regression stratified by location and wave of the pandemic and accounted for age, sex, comorbidities, smoking, obesity, housing density and deprivation. We included 2 692 223 people over 67 years in Wave 1 (1 February 2020–31 August 2020) and 2 731 427 in Wave 2 (1 September 2020–31 January 2021).

Results

Multigenerational living was associated with increased risk of severe COVID-19 for White and South Asian older people in both waves [e.g. Wave 2, 67+ living with three other generations vs 67+-year-olds only: White hazard ratio (HR) 1.61 95% CI 1.38–1.87, South Asian HR 1.76 95% CI 1.48–2.10], with a trend for increased risks of severe COVID-19 with increasing generations in Wave 2. There was also an increased risk of severe COVID-19 in Wave 1 associated with living alone for White (HR 1.35 95% CI 1.30–1.41), South Asian (HR 1.47 95% CI 1.18–1.84) and Other (HR 1.72 95% CI 0.99–2.97) ethnicities, an effect that persisted for White older people in Wave 2.

Conclusions

Both multigenerational living and living alone were associated with severe COVID-19 in older adults. Older South Asian people are over-represented within multigenerational households in England, especially in the most deprived settings, whereas a substantial proportion of White older people live alone. The number of generations in a household, number of occupants, ethnicity and deprivation status are important considerations in the continued roll-out of COVID-19 vaccination and targeting of interventions for future pandemics.

Authors
  • Kevin Wing,
  • Daniel Grint,
  • Rohini Mathur,
  • Hamish Gibbs,
  • George Hickman,
  • Emily Nightingale,
  • Anna Schultze,
  • Harriet Forbes,
  • Vahé Nafilyan,
  • Krishnan Bhaskaran,
  • Elizabeth Williamson,
  • Thomas House,
  • Lorenzo Pellis,
  • Emily Herrett,
  • Nileesa Gautam,
  • Helen Curtis,
  • Christopher Rentsch,
  • Angel Wong,
  • Brian MacKenna,
  • Amir Mehrkar,
  • Seb Bacon,
  • Ian Douglas,
  • Stephen Evans,
  • Laurie Tomlinson,
  • Ben Goldacre,
  • Rosalind Eggo
Citation
Kevin Wing, Daniel J Grint, Rohini Mathur, Hamish P Gibbs, George Hickman, Emily Nightingale, Anna Schultze, Harriet Forbes, Vahé Nafilyan, Krishnan Bhaskaran, Elizabeth Williamson, Thomas House, Lorenzo Pellis, Emily Herrett, Nileesa Gautam, Helen J Curtis, Christopher T Rentsch, Angel Y S Wong, Brian MacKenna, Amir Mehrkar, Seb Bacon, Ian J Douglas, Stephen J W Evans, Laurie Tomlinson, Ben Goldacre, Rosalind M Eggo, on behalf of the OpenSAFELY consortium, Association between household composition and severe COVID-19 outcomes in older people by ethnicity: an observational cohort study using the OpenSAFELY platform, International Journal of Epidemiology, Volume 51, Issue 6, December 2022, Pages 1745–1760, https://doi.org/10.1093/ije/dyac158
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