Risk Factors Associated With Mortality Among Residents With Coronavirus Disease 2019 (COVID-19) in Long-term Care Facilities in Ontario, Canada.
JAMA Netw Open
; 3(7): e2015957, 2020 07 01.
Article
em En
| MEDLINE
| ID: mdl-32697325
ABSTRACT
Importance The coronavirus disease 2019 (COVID-19) pandemic has been particularly severe among individuals residing in long-term care (LTC) facilities. As of April 10, 2020, half of Canada's COVID-19 deaths had occurred in LTC facilities. Objective:
To better understand trends and risk factors associated with COVID-19 death in LTC facilities in Ontario, Canada. Design, Setting, andParticipants:
This cohort study of 627 LTC facilities included 269 total individuals who died of COVID-19 in Ontario to April 11, 2020, and 83 individuals who died of COVID-19 in Ontario LTC facilities to April 7, 2020. Because population denominators were not available for LTC residents, they were approximated as the total number of LTC facility beds in Ontario (79â¯498), assuming complete occupancy. Exposures Confirmed or suspected COVID-19 outbreaks; confirmed COVID-19 infection among residents and staff, diagnosed by real-time polymerase chain reaction testing. Main Outcomes andMeasures:
COVID-19-specific mortality incidence rate ratios (IRRs) for LTC residents were calculated with community-living Ontarians older than 69 years as the comparator group. Count-based regression methods were used to model temporal trends and to identify associations of infection risk among staff and residents with subsequent LTC resident death. Model-derived IRRs for COVID-19-specific mortality were generated through bootstrap resampling (1000 replicates) to generate median and 95% credible intervals for IRR over time.Results:
Of 627 LTC facilities, 272 (43.4%) reported COVID-19 infection in residents or staff. Of 1â¯731â¯315 total individuals older than 69 years living in Ontario during the study period, 229 (<0.1%) died; of 79â¯498 potential residents in LTC facilities, 83 (0.1%) died. The IRR for COVID-19-related death in LTC residents was 13.1 (95% CI, 9.9-17.3) compared with community-living adults older than 69 years. The IRR increased sharply over time and was 87.3 (95% credible interval, 6.4-769.8) by April 11, 2020. Infection among LTC staff was associated with death among residents with a 6-day lag (eg, adjusted IRR for death per infected staff member, 1.17; 95% CI, 1.11-1.26). Conclusions and Relevance In this cohort study of COVID-19-related deaths during the pandemic in Ontario, Canada, mortality risk was concentrated in LTC residents and increased during a short period. Early identification of risk requires a focus on testing, providing personal protective equipment to staff, and restructuring the LTC workforce to prevent the movement of COVID-19 between facilities.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Contexto em Saúde:
1_ASSA2030
/
2_ODS3
/
4_TD
/
6_ODS3_enfermedades_notrasmisibles
Problema de saúde:
1_doencas_nao_transmissiveis
/
1_doencas_transmissiveis
/
1_surtos_doencas_emergencias
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2_muertes_prematuras_enfermedades_notrasmisibles
/
4_covid_19
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4_pneumonia
/
6_other_respiratory_diseases
Assunto principal:
Pneumonia Viral
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Assistência de Longa Duração
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Infecções por Coronavirus
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Betacoronavirus
Tipo de estudo:
Diagnostic_studies
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Etiology_studies
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Incidence_studies
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Observational_studies
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Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
/
Aged80
/
Humans
País/Região como assunto:
America do norte
Idioma:
En
Revista:
JAMA Netw Open
Ano de publicação:
2020
Tipo de documento:
Article
País de afiliação:
Canadá