Background: To assess whether inequalities existed across the eight health areas of Castilla-La Mancha (Spain) in all-cause and COVID-19 mortality in long-term care homes during 2020, and whether these differences were explained by COVID-19 incidence in the corresponding health areas.
Methods: Data were obtained from the Castilla-La Mancha Transparency Portal. Care homes were classified by health area, size, ownership, and COVID-19 incidence at the health-area level. Poisson regression models were used to estimate risk ratios for all-cause and COVID-19 mortality in each health area, using Toledo as the reference, and adjusting for size, ownership, and health-area COVID-19 incidence.
Results: Among 310 care homes (25,150 places), 4,460 deaths were recorded, including 2,821 attributed to COVID-19. All-cause mortality ranged from 7% in care homes in Talavera to 26% in those in Ciudad Real, while COVID-19 mortality ranged from 4% in care homes in Puertollano to 17% in care homes in Ciudad Real. In adjusted analyses, care homes in Ciudad Real, Guadalajara, Albacete, and Puertollano had higher all-cause mortality risk than those in Toledo, whereas those in Talavera showed lower risk. Only care homes in Albacete showed higher risk of COVID-19 mortality compared with those in Toledo.
Conclusions: Substantial territorial inequalities in mortality risk are observed in long-term care homes in Castilla-La Mancha for 2020. These inequalities were only partially explained by the community incidence of COVID-19.