Risk Factors Associated With Mortality Among Residents With Coronavirus Disease 2019 (COVID-19) in Long-term Care Facilities in Ontario, Canada
Risk Factors Associated With Mortality Among Residents With Coronavirus Disease 2019 (COVID-19) in Long-term Care Facilities in Ontario, Canada
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DOI：
10.1001/jamanetworkopen.2020.15957
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发表时间：
2020-07-22
影响因子：
13.8
通讯作者：
Tuite, Ashleigh R.
中科院分区：
文献类型：
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作者：
Fisman, David N.;Bogoch, Isaac;Tuite, Ashleigh R.
重要性 2019 年冠状病毒病 (COVID-19) 疫情在长期护理 (LTC) 机构中居住的个人中尤为严重。截至 2020 年 4 月 10 日，加拿大一半的 COVID-19 死亡发生在 LTC 设施中。 目的 更好地了解加拿大安大略省 LTC 设施中与 COVID-19 死亡相关的趋势和风险因素。 设计、设置和参与者 这项对 627 个 LTC 设施进行的队列研究包括截至 2020 年 4 月 11 日在安大略省死于 COVID-19 的 269 人，以及安大略省 LTC 设施中死于 COVID-19 的 83 人截至 2020 年 4 月 7 日。由于无法获得 LTC 居民的人口分母，因此假设完全占用，则将其近似为安大略省 LTC 设施床位总数 (79 498)。通过实时聚合酶链反应检测确诊居民和工作人员感染了 COVID-19。 主要结果和措施 LTC 居民的 COVID-19 特异性死亡率发生率 (IRR) 以 69 岁以上的社区居住的安大略人作为比较组进行计算。基于计数的回归方法用于对时间趋势进行建模，并确定工作人员和居民中的感染风险与随后的 LTC 居民死亡之间的关联。通过自举重采样（1000 次重复）生成模型得出的 COVID-19 特定死亡率的 IRR，以随着时间的推移生成 IRR 的中值和 95% 可信区间。结果 在 627 个 LTC 设施中，272 个 (43.4%) 报告居民或工作人员感染了 COVID-19。在研究期间居住在安大略省的 1 731315 名 69 岁以上老年人中，有 229 人（< 0.1%）死亡；在 LTC 设施中的 79 498 名潜在居民中，有 83 人 (0.1%) 死亡。与 69 岁以上的社区生活成年人相比，LTC 居民中与 COVID-19 相关的死亡的 IRR 为 13.1（95% CI，9.9-17.3）。随着时间的推移，IRR 急剧上升，到 2020 年 4 月 11 日为 87.3（95% 可信区间，6.4-769.8）。LTC 工作人员的感染与滞后 6 天的居民死亡相关（例如，每个受感染工作人员死亡的调整后 IRR，1.17；95% CI，1.11-1.26）。 结论和相关性加拿大安大略省大流行期间与 COVID-19 相关的死亡，死亡风险集中在 LTC 居民中，并在短期内增加。早期识别风险需要重点关注测试、为员工提供个人防护设备以及重组 LTC 员工队伍，以防止 COVID-19 在设施之间传播。
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, and Participants 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 (79 498), 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 and Measures 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 1 731315 total individuals older than 69 years living in Ontario during the study period, 229 (< 0.1%) died; of 79 498 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.