Infectious Disease

SARS-CoV-2 infection in nursing homes in connection with the establishment of the district

April 25, 2021

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The risk of SARS-CoV-2 infection in residents of long-term care homes is related to the district and the residential facility, according to the study results published in JAMA Network Open.

The analysis also showed that the risk of hospitalization and death after infection were related to the characteristics of the facility and the resident.

Nursing home infographic

Source: Mehta HB et al. JAMA Netw Open. 2021; doi: 10.1001 / jamanetworkopen.2021.6315.

“For many resident characteristics, there are significant differences between hospitalization risk and mortality.” Hemalkumar B. Mehta, PhD, an assistant professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health, and colleagues wrote. “This can represent resident preferences, triaging decisions, or an inadequate assessment of the risk of death.”

Mehta and colleagues conducted a retrospective cohort study of long-term residents 65 and older who had a Medicare fee. Between April 1 and September 30, 2020, a total of 482,323 residents from 15,038 nursing homes were analyzed. The researchers assessed the association of patient characteristics with the results, as well as the risk for the SARS-CoV-2 diagnosis.

Of the residents, 28.4% were diagnosed with SARS-CoV-2 and 21.3% were hospitalized. A total of 19.2% of the population died within 30 days of the analysis. Individual nursing homes accounted for 37.2% of the variation in infection risk, and a single county accounted for 23.4% of the variation in infection risk.

The risk of infection increased with the body mass index (adjusted HR = 1.19; 95% CI, 1.15-1.24). The hospital risk after SARS-CoV-2 also increased with the BMI (aHR = 1.4; 95% CI, 1.28-1.52), male (aHR = 1.32; 95% CI, 1.29-1 , 35), black (aHR = 1.28; 95%) CI, 1.24-1.32), Spanish (aHR = 1.2; 95% CI, 1.15-1.26) or Asian (aHR = 1.46; 95% CI, 1.36-1.57). Impaired functional status (aHR = 1.15; 95% CI, 1.1-1.22), kidney disease (aHR = 1.21; 95% CI, 1.18-1.24) and diabetes (aHR = 1 , 16; 95% CI, 1.13-1.18) were also associated with hospital risk.

The risk of mortality increased with impaired cognition (aHR = 1.79; 95% CI, 1.71-1.86), functional impairment (aHR = 1.94; 95% CI, 1.83-2.05) and age ( aHR = 2.55; 95% CI, 2.44-2.67). .

“For US nursing home residents diagnosed with SARS-CoV-2, there was an inconsistent relationship between the risk of hospitalization and increasing age,” the researchers wrote. “This may represent a preference for residents or families to avoid hospital stays, or to make decisions in areas where hospital beds have been scarce, or poor clinical evaluation and prognosis in facilities overwhelmed by the pandemic, or a combination this or other declarations. Understanding this phenomenon may require a qualitative approach. “

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