COVID-19Pandemic in Assisted Living Communities: Results from Seven States
COVID-19Pandemic in Assisted Living Communities: Results from Seven States
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DOI：
10.1111/jgs.16850
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发表时间：
2020-10-07
影响因子：
6.3
通讯作者：
Li, Yue
中科院分区：
文献类型：
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作者：
Temkin-Greener, Helena;Guo, Wenhan;Li, Yue
目的描述辅助生活（AL）居民中COVID-19确诊病例和死亡的变化，并检查其与AL关键特征的关联。设计：观察性研究，采用2020年5月29日之前来自7个州的确诊COVID-19病例和AL死亡数据。关于AL中COVID-19病例/死亡的信息来自州政府网站。使用全国AL清单来确定有和没有COVID-19病例/死亡的社区。确定AL居民的医疗保险受益人摘要文件被用来开发AL特征。县级COVID-19实验室确诊病例/死亡病例来自公开数据。我们在七个州发现了4，865例AL（2，647例COVID-19病例和777例死亡）。排除缺失数据后，样本包括3，994例AL（82.1%），其中2，542例病例（96.0%）和675例死亡（86.9%）。主要结局和指标结局是AL水平的病例和死亡计数。协变量为AL特征和县级确诊COVID-19病例/死亡。多变量两部分模型确定了独立变量与AL中至少一例病例和死亡的可能性以及病例（死亡）计数的相关性。结果：各州病死率从北卡罗来纳州的3.32%到康涅狄格州的9.26%不等，但这两个州的AL分别为12.89%和31.59%。在至少有一例病例的AL中，中型社区的病例数（发病率比（IRR）= 0.829;P= 0.004）少于小型AL。少数民族比例较高的AL有更多的COVID-19病例（IRR = 1.08;P< .001），痴呆症、慢性阻塞性肺病和肥胖居民比例较高的社区也是如此。结论和相关性少数民族比例较高的AL有更多的COVID-19病例。许多以前确定的个人风险因素也存在于这一脆弱群体中。COVID-19对AL的影响与对养老院的影响一样重要，值得政策制定者同等关注。
OBJECTIVE To describe variations in COVID-19 confirmed cases and deaths among assisted living (AL) residents and examine their associations with key AL characteristics. DESIGN Observational study employing data on confirmed COVID-19 cases and deaths in ALs from seven states, through May 29, 2020. SETTING Information on COVID-19 cases/deaths in ALs was obtained from state government websites. A national inventory of ALs was used to identify communities with and without COVID-19 cases/deaths. Medicare Beneficiary Summary File identifying AL residents was employed to develop AL characteristics. County-level COVID-19 laboratory-confirmed cases/deaths were obtained from publicly available data. PARTICIPANTS We found 4,865 ALs (2,647 COVID-19 cases and 777 deaths) in the seven states. After excluding missing data, the sample consisted of 3,994 ALs (82.1%) with 2,542 cases (96.0%) and 675 deaths (86.9%). MAIN OUTCOMES AND MEASURES Outcomes were AL-level counts of cases and deaths. Covariates were AL characteristics and county-level confirmed COVID-19 cases/deaths. Multivariable two-part models determined the associations of independent variables with the likelihood of at least one case and death in the AL, and with the count of cases (deaths). RESULTS State case fatality ranged from 3.32% in North Carolina to 9.26% in Connecticut, but for ALs in these states it was 12.89% and 31.59%, respectively. Among ALs with at least one case, midsize communities had fewer cases (incidence rate ratio (IRR) = 0.829;P= .004) than small ALs. ALs with higher proportions of racial/ethnic minorities had more COVID-19 cases (IRR = 1.08;P< .001), as did communities with higher proportions of residents with dementia, chronic obstructive pulmonary disease, and obesity. CONCLUSIONS AND RELEVANCE ALs with a higher proportion of minorities had more COVID-19 cases. Many of the previously identified individual risk factors are also present in this vulnerable population. The impact of COVID-19 on ALs is as critical as that on nursing homes, and is worth equal attention from policy makers.