Incidence, Mortality, and Risk Factors of COVID-19 in Nursing Homes
Abstract
:1. Introduction
2. Materials and Methods
2.1. Explanation
2.2. Statistical Analysis
- −
- Residents: mean age (years), women percentage (%), degree three of disability (%). The used index of disability, based on level of dependence, comprehended four degrees: 0 (no disability); 1 minor disability (mild dependence); 2 moderate disabilities (maintains autonomy daily life); 3 severe/profound disabilities. Degree three of disability needs help for functions like grooming, dressing, feeding, or going to bed.
- −
- Nursing home: ownership (private or public), size (number of residents less than 100, or ≥100), municipality where NHs were located, large urban area (≥50,000 inhabitants), urban area (≥10,000–49,999 inhabitants), semi-urban area (≥2500–9999 inhabitants), and rural area (≤2500 inhabitants). NHs facilities: number of beds, baths, and bathrooms; in addition, number of single and double bedrooms, and bedrooms with three beds.
- −
- Occupancy rate: resident population/NH beds.
- −
- Staff: number of total staff, number of registered nurses, number of nursing assistants. Ratios: residents/staff, residents/registered nurses, residents/nursing assistant, beds/staff, beds/nurse assistant, and bathrooms/residents.
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variables | |
---|---|
Residents | N = 2229 |
Age median of means (range) | 83 years (59–87) |
Women percentage (median range) | 67.3% (33.6–100%) |
Disability (median range) 1 | |
0 None | 4.3% (0–23.3%) |
1Mild/Minor | 12.5% (0–66.3%) |
2 Moderate | 41.6% (16.1–71.55%) |
3 Severe/Profound | 36.3% (4.0–73.4%) |
Staff | N = 1666 |
Registered nurses | N = 104 |
Nursing assistants | N = 733 |
Nursing homes | N = 27 |
Age of the building (median range) 2 | 16 (5–41) years |
Beds | N = 2490 |
Occupancy rate (median range) | 92.9% (52–100%) |
Bathrooms | N = 1424 |
Single bedrooms | N = 662 (41.6%) |
Double bedrooms | N = 899 (56.5%) |
Three bedrooms | N = 30 (1.9%) |
Ratios (median range) | |
Residents/staff | 1.49 (0.86–2.57) |
Residents/registered nurse | 23.7 (1.7–130.0) |
Residents/nursing assistant | 3.23 (0.56–5.53) |
Beds/staff | 1.56 (0.91–3.09) |
Beds/nursing assistant | 3.49 (1.84–6.48) |
Bathrooms/resident | 0.64 (0.1–1.41) |
Crowding index | 1.64 (0.70–2.13) |
Nursing homes’ capacity | |
Compartmentalization | 22 (81.5%) |
Isolation | 26 (96.7%) |
Quarantines | 26 (96.3%) |
Total Population | Outcomes | Mean ± SD 1 | Median (Range) |
---|---|---|---|
Cases 2 | Cumulative incidence rate | Cumulative incidence rate | |
Residents | 815 | 34.8% ± 35.7 | 25.3% (0–103.0) |
Staff | 296 | 19.2% ± 18.2 | 11.7% (0–63.6) |
Deaths | Mortality rate | Mortality rate | |
Residents | 202 | 8.7% ± 9.4 | 6.3% (0–30.2) |
Staff | 0 | 0 | 0 |
Variables | CIR 1 | cRR 2,3 95% CI 4 | p-Value | Arr 5 95% CI | p-Value |
---|---|---|---|---|---|
Ownership | |||||
Private 6 | 25.4% | 1.26 (1.08–1.47) | 0.003 | 1.45 (1.21–1.74) | 0.000 |
Public | 15.0% | 1.00 | 1.00 | ||
Size 7 | |||||
N ≥ 100 residents | 28.2% | 1.04 (0.88–1.24) | 0.000 | 1.39 (1.10–1.77) | 0.006 |
N ≤ 100 | 7.1% | 1.00 | 1.00 | ||
Large urban area 8 | |||||
≥50,000 inhabitants. | 50.0% | 2.46 (2.10–2.86) | 0.000 | 2.14 (1.28–3.56) | 0.004 |
<50,000 inhabitants. | 5.6% | 1.00 | 1.00 | ||
Residents (median values) | |||||
Severe disability 9,10 > 36.3% | 28.2% | 1.01 (1.00–1.02) | 0.000 | 1.00 (0.99–1.01) | 0.497 |
≤36.3% | 3.3% | 1.00 | 1.00 | ||
Age (mean) 10,11 > 82.5 years | 15.4% | 0.98 (0.97–0.99) | 0.000 | 0.99 (0.98–1.01) | 0.364 |
≤82.5 years | 25.4% | 1.00 | 1.00 | ||
Women% 10,12 > 67.3% | 25.3% | 1.13 (0.60–2.13) | 0.705 | 3.01 (1.11–8.53) | 0.031 |
≤67.3% | 24.4% | 1.00 | 1.00 |
Variables (Median Values) | CIR 1 | cRR 2,3 95% CI 4 | p-Value | aRR 5 95% CI | p-Value |
---|---|---|---|---|---|
CIR municipalities 6,7 > 2820 per 100.000 | 3.7% | 1.01 (1.00–1.02) | 0.000 | 1.01 (0.99–1.02) | 0.341 |
≤2820 per 100.000 | 26.8% | 1.00 | 1.00 | ||
CIR staff 6,8 > 11.7 per 100 | 73.5% | 38.37 (28.21–53.40) | 0.000 | 49.7 (33.0–78.2) | 0.000 |
≤11.7 per 100 | 2.1% | 1.00 | 1.00 | ||
Age of NHs building 6,9 > 16 years | 7.1% | 1.03 (1.02–1.04) | 0.000 | 1.06 (1.04–1.08) | 0.000 |
≤16 years | 27.5% | 1.00 | 1.00 | ||
Occupancy rate 6,9 > 92.9% | 26.1% | 1.47 (1.28–1.70) | 0.000 | 2.09 (1.69–2.58) | 0.000 |
≤92.9% | 15.4% | 1.00 | 1.00 | ||
Residents/staff ratio 6,9 > 1.49 | 52.0% | 1.61 (1.40–1.87) | 0.000 | 1.41 (1.09–1.82) | 0.010 |
≤1.49 | 15.0% | 1.00 | 1.00 | ||
Residents/nursing assistant ratio 6,9 > 3.23 | 52.0% | 1.34 (1.26–1.43) | 0.000 | 1.38 (1.24–1.54) | 0.000 |
≤3.23 | 15.8% | 1.00 | 1.00 | ||
Beds/staff ratio 6,9 > 1.56 | 28.2% | 1.18 (1.05–1.33) | 0.000 | 0.82 (0.65–1.05) | 0.111 |
≤1.56 | 6.3% | 1.00 | 1.00 | ||
Beds/nursing assistant ratio 6,9 > 3.49 | 25.4% | 1.14 (1.09–1.21) | 0.000 | 1.11 (1.01–1.22) | 0.024 |
≤3.49 | 15.8% | ||||
Bathrooms/resident ratio 6,9 > 0.61 | 5.6% | 0.61 (0.44–0.84) | 0.000 | 1.38 (0.84–2.29) | 0.205 |
≤0.61 | 26.1% | 1.00 | 1.00 | ||
Crowding index 6,9 > 1.64 | 39.4% | 1.48 (1.17–1.88) | 0.009 | 2.29 (1.69–3.10) | 0.000 |
≤1.64 | 5.6% | 1.00 | 1.00 |
Variables | MR 1 | cRR 2,3 95% CI 4 | p-Value | aRR 5 95% CI | p-Value |
---|---|---|---|---|---|
Ownership | |||||
Private 6 | 7.3% | 0.97 (0.72–1.30) | 0.825 | 0.98 (0.69–1.39) | 0.902 |
Public | 2.3% | 1.00 | 1.00 | ||
Size 7 | |||||
N ≥ 100 residents | 7.5% | 1.47 (1.11–1.95) | 0.008 | 1.04 (0.64–1.70) | 0.877 |
N < 100 residents | 1.9% | 1.00 | 1.00 | ||
Large urban area 8 | |||||
≥50,000 inhabitants | 7.7 | 1.99 (1.48–2.67) | 0.000 | 1.92 (0.60–6.20) | 0.273 |
<50,000 inhabitants | 1.6 | 1.00 | 1.00 | ||
Next hospital distance (Km) | 1.00 (0.99–1.02) | 0.677 | 0.99 (0.97–1.02) | 0.596 | |
Residents (median values) | |||||
Severe disability 9,10 | |||||
>36.3% | 7.5% | 1.02 (1.01–1.03) | 0.000 | 1.01 (1.00–1.02) | 0.045 |
≤36.3% | 1.9% | 1.00 | 1.00 | ||
Age (mean) 9,11 | |||||
>82.5 years | 3.8% | 0.99 (0.96–1.01) | 0.300 | 1.00 (0.97–1.03) | 0.920 |
≤82.5 years | 6.3% | 1.00 | 1.00 | ||
Women % 9,12 > 67.3% | 5.0% | 0.83 (0.24–2.86) | 0.763 | 4.41 (0.75–25.85) | 0.100 |
≤67.3% | 4.9% | 1.00 | 1.00 |
Variables (Median Values) | MR 1 | cRR 2,3 95% CI 4 | p-Value | aRR 5 95% CI | p-Value |
---|---|---|---|---|---|
CIR staff 6,7,8 > 11.7 per 100 | 19.5% | 45.6 (22.6–96.7) | 0.000 | 59.9 (26.64–134.81) | 0.000 |
≤11.7 per 100 | 1.3% | 1.00 | 1.00 | ||
CIR municipalities 6,10 > 2820 per 100.000 | 0.9% | 1.01 (0.99–1.03) | 0.413 | 1.02 (0.99–1.05) | 0.261 |
≤2820 per 100.000 | 7.7% | 1.00 | 1.00 | ||
Age of NHs building 6,11 > 16 years | 6.3% | 1.04 (1.02–1.07) | 0.006 | 1.08 (1.04–1.11) | 0.000 |
≤16 years | 3.8% | 1.00 | 1.00 | ||
Occupancy rate 6,9 < 92.9% | 5.0% | 1.82 (1.36–2.44) | 0.000 | 1.86 (1.22–2.82) | 0.000 |
≤92.9% | 1.5% | 1.00 | 1.00 | ||
Residents/staff ratio 6,11 > 1.49 | 8.7% | 0.89 (0.64–1.23) | 0.480 | 0.95 (0.54–1.66) | 0.862 |
≤1.49 | 2.3% | 1.00 | 1.00 | ||
Residents/nursing assistant ratio 6,11 > 3.23 | 8.0% | 1.12 (0.96–1.30) | 0.142 | 1.44 (1.14–1.82) | 0.002 |
≤3.23 | 2.8% | 1.00 | 1.00 | ||
Bed/staff ratio 6,11 > 1.56 | 7.5% | 0.75 (0.58–0.93) | 0.033 | 0.71 (0.45–1.12) | 0.144 |
≤1.56 | 1.9% | 1.00 | 1.00 | ||
Beds/nursing assistant ratio 6,11 > 3.36 | 7.5% | 1.04 (0.99–1.11) | 0.095 | 1.17 (0.96–1.42) | 0.120 |
≤3.36 | 2.8% | 1.00 | 1.00 | ||
Bathrooms/resident ratio 6,11 >0.61 | 1.9% | 0.28(0.13–0.57) | 0.000 | 1.15 (0.38–3.54) | 0.801 |
≤0.61 | 7.0% | 1.00 | 1.00 | ||
Crowding index 6,11 > 1.64 | 9.5% | 2.57 (1.58–4.19) | 0.000 | 3.11 (1.55–6.26) | 0.000 |
≤1.64 | 1.9% | 1.00 | 1.00 |
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Arnedo-Pena, A.; Romeu-Garcia, M.A.; Gascó-Laborda, J.C.; Meseguer-Ferrer, N.; Safont-Adsuara, L.; Prades-Vila, L.; Flores-Medina, M.; Rusen, V.; Tirado-Balaguer, M.D.; Sabater-Vidal, S.; et al. Incidence, Mortality, and Risk Factors of COVID-19 in Nursing Homes. Epidemiologia 2022, 3, 179-190. https://doi.org/10.3390/epidemiologia3020014
Arnedo-Pena A, Romeu-Garcia MA, Gascó-Laborda JC, Meseguer-Ferrer N, Safont-Adsuara L, Prades-Vila L, Flores-Medina M, Rusen V, Tirado-Balaguer MD, Sabater-Vidal S, et al. Incidence, Mortality, and Risk Factors of COVID-19 in Nursing Homes. Epidemiologia. 2022; 3(2):179-190. https://doi.org/10.3390/epidemiologia3020014
Chicago/Turabian StyleArnedo-Pena, Alberto, Maria Angeles Romeu-Garcia, Juan Carlos Gascó-Laborda, Noemi Meseguer-Ferrer, Lourdes Safont-Adsuara, Laura Prades-Vila, Matilde Flores-Medina, Viorica Rusen, Maria Dolores Tirado-Balaguer, Susana Sabater-Vidal, and et al. 2022. "Incidence, Mortality, and Risk Factors of COVID-19 in Nursing Homes" Epidemiologia 3, no. 2: 179-190. https://doi.org/10.3390/epidemiologia3020014