# Differences in Covid-19 mortality among persons 70 years and older in an integrated care setting in region Stockholm: a multi-level analysis between March 2020-February 2021

## TL;DR

This study examines how integrated care in Norrtälje, Sweden, affected COVID-19 mortality among older adults compared to other areas.

## Contribution

The study evaluates the impact of integrated care on reducing COVID-19 mortality in older populations during a pandemic.

## Key findings

- Integrated care in Norrtälje may have led to a more coordinated pandemic response.
- Individual factors like age and health explained most of the variation in mortality.
- Area-level variables like deprivation and population density also influenced outcomes.

## Abstract

In Norrtälje municipality, within Region Stockholm, there is a joint integrated care organisation providing health and social care, which may have facilitated a more coordinated response to the covid-19 pandemic compared to the otherwise decentralised Swedish system. This study compares the risk of covid-19 mortality among persons 70 years and older, in the municipalities of Stockholm, Södertälje, and Norrtälje, while considering area and individual risk factors.

A population-based study using linked register data to examine covid-19 mortality among those 70 + years (N = 127,575) within the municipalities of interest between the periods March-August 2020 and September 2020-February 2021. The effect of individual and area level variables on covid-19 mortality among inhabitants in 68 catchment areas were examined using multi-level logistic models.

Individual factors associated with covid-19 mortality were sex, older age, primary education, country of birth and poorer health as indicated by the Charlson Co-morbidity Index. The area-level variables associated were high deprivation (OR: 1.56, CI: 1.18–2.08), population density (OR: 1.14, CI: 1.08–1.21), and usual care. Together, this explained 85.7% of the variation between catchment areas in period 1 and most variation was due to individual risk factors in period 2. Little of the residual variation was attributed to differences between catchment areas.

Integrated care in Norrtälje may have facilitated a more coordinated response during period 1, compared to municipalities with usual care. In the future, integrated care should be considered as an approach to better protect and meet the care needs of older people during emergency situations.

The online version contains supplementary material available at 10.1186/s12889-024-17904-4.