Project #49:
Association between household composition and severe COVID-19 outcomes in older people by ethnicity: an observational cohort study using the OpenSAFELY platform

Ethnic differences in the risk of severe COVID-19 may be linked to ethnic differences in household composition. In this study our aim was to assess whether household composition (= the number of age-based generations in a household) was associated with risk of severe COVID-19 for older individuals (people aged 67 or older) after taking account of other risk factors for severe COVID-19, and whether this association differed by ethnicity.

We created a cohort that included all people over the age of 67 in OpenSAFELY, and analysed whether the number of younger generations that the 67+ year old lived with was associated with their risk of being hospitalised or dying from COVID-19. We performed separate analyses for wave 1 (01/02/2020-31/08/2020) and wave 2 (01/09/2020-31/01/2021) in the UK, and analysed the effect of the following living arrangements: 67+ year old living alone, 67+ year old living with other 67+ year olds, 67+ year old living with people from 1 younger generation, 67+ year old living with people from 2 younger generations, 67+ year olds living with people from 3 younger generations (with distinct younger generations defined as 0-18, 18-29, 30-66). For all analyses, we assessed whether observed effects were different by ethnic group (defined as White, Black, South Asian, Mixed and Other).

Initial results showed that in Wave 1 there was no association between household composition and severe COVID-19 for any ethnicity, but that in wave 2 living with increasing numbers of younger generations was associated with an increased risk of severe COVID-19 for White and for South Asian people. We also found that older South Asian people are over-represented within multi-generational household in the most deprived settings, and older people in these settings have a particularly high risk of severe COVID-19.