Mortality risk factors in the Catalan long-term care system

As populations age, understanding the health impact of long-term care systems is critical for shaping effective policy. This study investigates the association between long-term care benefits and mortality risk among older adults in Catalonia, Spain, using comprehensive administrative data from July 2015 to December 2024. The analysis focuses on individuals aged 50+ who were assessed for long-term care needs, categorizing them by severity (Grades I–III) and type of benefit received: home care, residential care, a combination of both or no benefit. Applying survival analysis techniques—including Kaplan-Meier estimators and Cox proportional hazards models—it finds that individuals with long-term care needs receiving benefits have significantly lower mortality hazards. Notably, individuals transitioning from home to residential care exhibit the most favourable hazard ratios, suggesting that responsive care pathways are associated with better survival outcomes, potentially due to a most accurate matching of care to needs. Residential care alone is associated to higher mortality risk than home care in the population with the highest grades of long-term care needs. Individuals with recognized longterm care needs who do not receive any benefits face significantly higher risks, a pattern that may reflect the consequences of unmet care needs. Mortality risk varies by sex, age, and clinical profile, with higher hazards observed among men, older individuals, and those with haematological, neoplastic, or respiratory conditions. These findings underscore the association between formal long-term care systems and lower mortality risk and emphasize the importance of timely, adaptive care pathways in mitigating health decline among aging populations.