Incidence, Mortality, and Risk Factors of COVID-19 in Nursing Homes

Abstract

During the period from March 2020 to January 2021, we performed an analysis of incidence, mortality, and risk factors of COVID-19 in nursing homes (NHs) in two health departments (HDs) of Castellon (Spain) 2021 through epidemiological surveillance and an ecological design. Laboratory-confirmed COVID-19 cases, cumulative incidence rate (CIR), and mortality rate (MR) of 27 NHs were collected. Information of residents, staff, and facilities was obtained by questionnaire. Multilevel Poisson regression models were applied. All NHs in the HDs participated with 2229 residents (median: 83 years old, 67.3% women) and 1666 staff. Among residents, 815 cases (CIR: 34.8 per 100) and 202 deaths (MR: 8.7 per 100, case fatality 21.0%) were reported and, among staff, 296 cases (CIR: 19.2 per 100) without deaths. Residents’ CIR and MR increased with staff CIR, age of the building, residents/staff ratios, occupancy rate, and crowding index; CIR increased with private NH ownership, large NH size, large urban area, and the percentage of women residents; and MR was associated with residents’ severe disabilities. In conclusion, several risk factors of COVID-19 incidence and mortality can be prevented by improving infection and quality controls, ameliorating residents/staff ratios, improving structural facilities, and increasing NH public ownership to avoid new outbreaks.

The Impact of Long-Term Care Home Ownership and Administration Type on All-Cause Mortality from March to April 2020 in Madrid, Spain

“…As a result, non-profit private as well as publicly owned and administered LTCHs may have had more funding available in times of crisis. However, it is not only financing that makes a difference as publicly administered LTCHs offer more stable job conditions, have higher staff ratios, and demand more professional training and experience [5,8,18].…”

“…A recent study conducted in the Province of Castellón (Spain) showed that a lower ratio of assistant nurses to residents and cumulative COVID-19 incidence in staff were significantly associated with higher mortality after adjusting for LTCH characteristics [18]. Although quantitative data on staff qualifications and working conditions in the Community of Madrid are unavailable, a recently published, large qualitative study conducted an in-depth analysis of the working conditions in LTCHs in several autonomous communities in Spain, including Madrid [26].…”

“…Potential confounders. According to the available literature we consider the following variables to be potential confounders of the association between mortality and LTCH type: size [3,17] and location [3,18].…”

Nursing homes and mortality in Europe: Uncertain causality

“…The pandemic has been particularly deadly for residents of nursing homes and other long‐term care facilities in the US and in European countries (Shen, 2022). Recent studies have pointed out the heterogeneity of the quality of the nursing homes (Cronin & Evans, 2022), the organization structure of the staff (Dean et al., 2022) and the private ownership of the nursing home (Arnedo‐Pena et al., 2022) as explaining factors of the excess mortality due to COVID‐19. These findings support our analysis of the potential mechanisms behind the excess mortality in nursing homes.…”

Public Perception towards Vaccines as Preventive Measures against a Twindemic (Seasonal Influenza and COVID-19): A Cross-Sectional Study from the Aseer Region, Saudi Arabia

“…Influenza and COVID-19 might be symptomatically identical and lead to more severe-course coinfections, consequences, or death outcomes. Moreover, COVID-19 spreads among high-risk categories the same way as seasonal influenza, which can harm older people and those with chronic comorbidity, including obese people and long-term care patients [ 10 , 11 , 12 , 13 ]. In a Brazilian study assessed by more than 92,000 COVID-19 patients, the death risks were 17% lower, the intensive care requirements were 8%, and the invasive response odds were 18% for those who obtained an influenza vaccine [ 14 ].…”