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.

中文翻译：

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按种族划分的老年人家庭构成与严重 COVID-19 结果之间的关联：一项使用 OpenSAFELY 平台的观察性队列研究

背景 严重 COVID-19 风险的种族差异可能与家庭构成有关。我们按种族对老年人的家庭构成与严重 COVID-19 风险之间的关联进行了量化。方法 在获得 NHS England 的批准后，我们​​分析了英格兰 67 岁或以上人群家庭构成与严重 COVID-19 之间关联的种族差异。我们根据共同生活的几代人的年龄来定义家庭，并使用多变量 Cox 回归按地点和大流行波进行分层，并考虑了年龄、性别、合并症、吸烟、肥胖、住房密度和剥夺。我们在第 1 波（2020 年 2 月 1 日至 2020 年 8 月 31 日）和第 2 波（2020 年 9 月 1 日至 2021 年 1 月 31 日）中纳入了 2 692 223 名 67 岁以上的人。在英格兰的多代家庭中，南亚老年人的比例过高，尤其是在最贫困的环境中，而相当一部分白人老年人独自生活。一个家庭的世代数、居住者人数、种族和贫困状况是继续推出 COVID-19 疫苗接种和针对未来大流行的干预措施的重要考虑因素。