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J Epidemiol
. 2025 May 3.
doi: 10.2188/jea.JE20240464. Online ahead of print. Impact of the COVID-19 Pandemic on New Long-term Care Insurance Applications and All-Cause Mortality in Older Adults in a Japanese Metropolitan Cohort: An Interrupted Time-Series Analysis
Satoshi Seino 1 2 , Toshiki Hata 1 3 , Hiroki Mori 1 , Shoji Shinkai 1 4 , Yoshinori Fujiwara 5 , Erika Kobayashi 1
Affiliations
Purpose: New long-term care insurance (LTCI) certifications and mortality are key outcomes in cohort studies involving older adults; however, the coronavirus disease 2019 (COVID-19)'s comprehensive impacts on these outcomes remain underexplored. We examined the pandemic's impact on new LTCI applications and all-cause mortality in a metropolitan cohort.
Methods: In 2016, 15,500 individuals aged 65-84 years were randomly selected through stratified sampling from Ota City, Tokyo. LTCI and death records were tracked through December 2023; the monthly LTCI applications and all-cause deaths per 10,000 people were calculated. The COVID-19 pandemic period was defined as beginning in March 2020, after the World Health Organization Director-General characterized the situation as a pandemic on March 11, 2020. Interrupted time-series segmented regression analysis was used to compare trends pre- (January 2018-February 2020) and post-pandemic onset (March 2020-December 2023).
Results: From January 2018 to December 2023, 4083 new LTCI applications and 2457 deaths were recorded. New monthly LTCI applications showed a modest upward trend pre-pandemic (0.4 per 10,000 people, 95% confidence interval [CI]: 0.1-0.8), declined sharply at the pandemic's onset (-9.6 per 10,000 people, 95% CI: -16.0 to -3.2), and subsequently increased at a higher rate than pre-pandemic levels (0.8 per 10,000 people, 95% CI: 0.6-1.0). Monthly all-cause deaths remained stable before and immediately after the pandemic's onset but rose slightly in the post-pandemic period (0.3 per 10,000 people per month, 95% CI: 0.2-0.5).
Conclusions: The COVID-19 pandemic influenced both new LTCI applications and all-cause mortality in this study. These impacts should be carefully considered in cohort studies examining these outcomes.
Keywords: COVID-19; interrupted time-series analysis; long-term care; mortality; older adults; pandemic.
. 2025 May 3.
doi: 10.2188/jea.JE20240464. Online ahead of print. Impact of the COVID-19 Pandemic on New Long-term Care Insurance Applications and All-Cause Mortality in Older Adults in a Japanese Metropolitan Cohort: An Interrupted Time-Series Analysis
Satoshi Seino 1 2 , Toshiki Hata 1 3 , Hiroki Mori 1 , Shoji Shinkai 1 4 , Yoshinori Fujiwara 5 , Erika Kobayashi 1
Affiliations
- PMID: 40335294
- DOI: 10.2188/jea.JE20240464
Purpose: New long-term care insurance (LTCI) certifications and mortality are key outcomes in cohort studies involving older adults; however, the coronavirus disease 2019 (COVID-19)'s comprehensive impacts on these outcomes remain underexplored. We examined the pandemic's impact on new LTCI applications and all-cause mortality in a metropolitan cohort.
Methods: In 2016, 15,500 individuals aged 65-84 years were randomly selected through stratified sampling from Ota City, Tokyo. LTCI and death records were tracked through December 2023; the monthly LTCI applications and all-cause deaths per 10,000 people were calculated. The COVID-19 pandemic period was defined as beginning in March 2020, after the World Health Organization Director-General characterized the situation as a pandemic on March 11, 2020. Interrupted time-series segmented regression analysis was used to compare trends pre- (January 2018-February 2020) and post-pandemic onset (March 2020-December 2023).
Results: From January 2018 to December 2023, 4083 new LTCI applications and 2457 deaths were recorded. New monthly LTCI applications showed a modest upward trend pre-pandemic (0.4 per 10,000 people, 95% confidence interval [CI]: 0.1-0.8), declined sharply at the pandemic's onset (-9.6 per 10,000 people, 95% CI: -16.0 to -3.2), and subsequently increased at a higher rate than pre-pandemic levels (0.8 per 10,000 people, 95% CI: 0.6-1.0). Monthly all-cause deaths remained stable before and immediately after the pandemic's onset but rose slightly in the post-pandemic period (0.3 per 10,000 people per month, 95% CI: 0.2-0.5).
Conclusions: The COVID-19 pandemic influenced both new LTCI applications and all-cause mortality in this study. These impacts should be carefully considered in cohort studies examining these outcomes.
Keywords: COVID-19; interrupted time-series analysis; long-term care; mortality; older adults; pandemic.