Risk Factors Associated With SARS-CoV-2 Infections, Hospitalization, and Mortality Among US Nursing Home Residents.
Risk Factors Associated With SARS-CoV-2 Infections, Hospitalization, and Mortality Among US Nursing Home Residents.
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DOI：
10.1001/jamanetworkopen.2021.6315
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发表时间：
2021-03-01
影响因子：
13.8
通讯作者：
Goodwin JS
中科院分区：
文献类型：
--
作者：
Mehta HB;Li S;Goodwin JS
哪些危险因素与疗养院居民的SARS-CoV-2感染、住院和死亡率有关？在这项队列研究中，482名SARS-CoV323名长期居住居民感染 -CoV2的风险与地理区域和特定设施有关，而不受居民特征的影响。在被诊断为SARS-CoV-2感染的居民中，与个人居民特征相关的住院风险与死亡风险不同。这些发现表明，对感染SARS-CoV-2的养老院居民进行住院治疗的决定与死亡风险并不一致。这项队列研究调查了与美国疗养院居民的SARS-CoV-2感染发生率、住院和死亡相关的危险因素。疗养院居民约占SARS-CoV-2死亡人数的40%。确定美国疗养院居民SARS-CoV-2发病率、住院率和死亡率的危险因素。这项回溯性纵向队列研究是在65岁或以上的长期住院居民中进行的，这些居民在2020年4月1日至2020年9月30日期间居住在15家 038美国养老院提供按服务收费的医疗保险。对2020年11月22日至2021年2月10日的数据进行了分析。主要结果是9月30日之前诊断为SARS-CoV-2(根据国际疾病统计分类，第10版，临床修改[ICD-10-CM]代码)的风险，以及在诊断后30天内住院或死亡。以疗养院设施为条件的三水平(居民、设施和县)Logistic回归模型和竞争风险模型被用来确定患者特征与预后的关联。在纳入的482名 长住居民中，平均年龄(SD)为82.7(9.2)岁，其中326名 861名(67.8%)女性，383名 838名居民(79.6%)。在随访的137名 119名居民(28.4%)中，29名 204名居民(21.3%)在30天内住院，26名 384名居民(19.2%)在30天内死亡。养老院解释了37.2%的感染风险变化，县解释了23.4%。感染风险随着身体质量指数(BMI；计算为体重(公斤)除以身高(米)的平方)而增加(例如，BMI>；45vsBMI 18.5-25：调整后的危险比[AHR]，1.19；95%CI，1.15-1.24)，但受其他居民特征的影响很小。SARS-CoV-2后住院的风险随着BMI的增加而增加(例如，BMI和GT；45vsBMI 18.5-25：AHR，1.40；95%CI，1.28-1.52)；男性(AHR，1.32；95%CI，1.29-1.35)；黑人(AHR，1.28；95%CI，1.24-1.32)；西班牙裔(AHR，1.20；95%CI，1.15-1.26)；或亚洲(AHR，1.46；95%CI，1.36-1.57)种族/民族；功能状态受损(例如，严重受损与未受损：AHR，1.15；95%CI，1.10-1.22)；以及日益增加的并发症，如肾脏疾病(AHR，1.21；95%CI，1.18-1.24)和糖尿病(AHR，1.16；95%CI，1.13-1.18)。死亡风险随着年龄(例如，90岁与65-70岁：AHR，2.55；95%CI，2.44-2.67)、认知受损(例如，严重受损与未受损：AHR，1.79；95%CI，1.71-1.86)和功能受损(例如，严重受损与未受损：AHR，1.94；1.83-2.05)而增加。这些结果表明，在长期居住的养老院居民中，SARS-CoV-2感染的风险与居住地区和居住设施有关，而SARS-CoV-2感染后住院和死亡的风险与设施和居民个人特征有关。就许多居民特征而言，住院风险与死亡率存在显著差异。这可能代表居民偏好、分诊决定或对死亡风险认识不足。
What risk factors are associated with SARS-CoV-2 infections, hospitalization, and mortality among nursing home residents? In this cohort study among 482 323 long-stay residents, risk of SARS-CoV-2 infections were associated with geographic area and the specific facility, not by characteristics of the residents. Among residents diagnosed with SARS-CoV-2 infections, the risk of hospitalization associated with individual resident characteristics differed from the risk of death. These findings suggest that decisions on hospitalization of nursing home residents with SARS-CoV-2 were inconsistently associated with risk of death. This cohort study examined risk factors associated with SARS-CoV-2 infection incidence, hospitalization, and death among nursing home residents in the US. Nursing home residents account for approximately 40% of deaths from SARS-CoV-2. To identify risk factors for SARS-CoV-2 incidence, hospitalization, and mortality among nursing home residents in the US. This retrospective longitudinal cohort study was conducted in long-stay residents aged 65 years or older with fee-for-service Medicare residing in 15 038 US nursing homes from April 1, 2020, to September 30, 2020. Data were analyzed from November 22, 2020, to February 10, 2021. The main outcome was risk of diagnosis with SARS-CoV-2 (per International Statistical Classification of Diseases, Tenth Revision, Clinical Modification [ICD-10-CM] codes) by September 30 and hospitalization or death within 30 days after diagnosis. Three-level (resident, facility, and county) logistic regression models and competing risk models conditioned on nursing home facility were used to determine association of patient characteristics with outcomes. Among 482 323 long-stay residents included, the mean (SD) age was 82.7 (9.2) years, with 326 861 (67.8%) women, and 383 838 residents (79.6%) identifying as White. Among 137 119 residents (28.4%) diagnosed with SARS-CoV-2 during follow up, 29 204 residents (21.3%) were hospitalized, and 26 384 residents (19.2%) died within 30 days. Nursing homes explained 37.2% of the variation in risk of infection, while county explained 23.4%. Risk of infection increased with increasing body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) (eg, BMI>45 vs BMI 18.5-25: adjusted hazard ratio [aHR], 1.19; 95% CI, 1.15-1.24) but varied little by other resident characteristics. Risk of hospitalization after SARS-CoV-2 increased with increasing BMI (eg, BMI>45 vs BMI 18.5-25: aHR, 1.40; 95% CI, 1.28-1.52); male sex (aHR, 1.32; 95% CI, 1.29-1.35); Black (aHR, 1.28; 95% CI, 1.24-1.32), Hispanic (aHR, 1.20; 95% CI, 1.15-1.26), or Asian (aHR, 1.46; 95% CI, 1.36-1.57) race/ethnicity; impaired functional status (eg, severely impaired vs not impaired: aHR, 1.15; 95% CI, 1.10-1.22); and increasing comorbidities, such as renal disease (aHR, 1.21; 95% CI, 1.18-1.24) and diabetes (aHR, 1.16; 95% CI, 1.13-1.18). Risk of mortality increased with age (eg, age >90 years vs 65-70 years: aHR, 2.55; 95% CI, 2.44-2.67), impaired cognition (eg, severely impaired vs not impaired: aHR, 1.79; 95% CI, 1.71-1.86), and functional impairment (eg, severely impaired vs not impaired: aHR, 1.94; 1.83-2.05). These findings suggest that among long-stay nursing home residents, risk of SARS-CoV-2 infection was associated with county and facility of residence, while risk of hospitalization and death after SARS-CoV-2 infection was associated with facility and individual resident characteristics. For many resident characteristics, there were substantial differences in risk of hospitalization vs mortality. This may represent resident preferences, triaging decisions, or inadequate recognition of risk of death.
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DOI：
10.1016/s2215-0366(20)30434-x
发表时间：
2020-12
期刊：
The lancet. Psychiatry
影响因子：
--
作者：
Livingston G;Rostamipour H;Gallagher P;Kalafatis C;Shastri A;Huzzey L;Liu K;Sommerlad A;Marston L
通讯作者：
Marston L
影响因子：
120.7
作者：
Li, Yue;Yin, Jun;Mukamel, Dana B.
通讯作者：
Mukamel, Dana B.
影响因子：
44.5
作者：
Holman, Naomi;Knighton, Peter;Valabhji, Jonathan
通讯作者：
Valabhji, Jonathan
影响因子：
13.8
作者：
Ioannou GN;Locke E;Green P;Berry K;O'Hare AM;Shah JA;Crothers K;Eastment MC;Dominitz JA;Fan VS
通讯作者：
Fan VS
影响因子：
6.3
作者：
Li, Yue;Cen, Xi;Temkin-Greener, Helena
通讯作者：
Temkin-Greener, Helena