Long-Term Care Home Size Association with COVID-19 Infection and Mortality in Catalonia in March and April 2020
Abstract
:1. Introduction
2. Materials and Methods
Statistical Analyses
3. Results
3.1. Bivariate Analyses: COVID-19 Infection as an Outcome
3.2. Bivariate Analyses: COVID-19 Mortality as an Outcome
3.3. Multivariate Analyses: COVID-19 Infection as an Outcome
3.4. Multivariate Analyses: Proportion of LTCHs with COVID-19 Mortality
3.5. Multivariate Analyses: Number of COVID-19 Deaths in LTCHs
3.6. Number of COVID-19 Deaths in an LTCH by LTCH Size at the Average County COVID-19 CIR
3.7. Number of COVID-19 Deaths in an LTCHs by LTCH Size Differed with County COVID-19 CIR Levels
3.8. COVID-19 Mortality at an LTCH by LTCH Size According to Five Levels of County COVID-19 CIR
4. Discussion
4.1. Summary of Results
4.2. Interpretation of Results Based on Available Literature
4.3. Study Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Unadjusted | Adjusted-I | Adjusted-II | ||||
---|---|---|---|---|---|---|
Coeff. | 95% CI | Coeff. | 95% CI | Coeff. | 95% CI | |
Intercept | −0.324 | −0.721–0.181 | −2.965 | −3.768–2.362 | −2.853 | −3.581–−2.244 |
LTCH size | 0.158 | −0.039–0.284 | 0.237 | 0.186–0.305 | 0.241 | 0.164–0.330 |
LTCH size 2 | 0.002 | −0.006–0.018 | n.s. | n.s. | n.s. | n.s. |
LTCH type | ||||||
For profit, completely privately administered | -- | -- | Ref. | Ref. | Ref. | Ref. |
Generalitat, publicly administered | -- | -- | 0.156 | −0.981–1.702 | n.s. | n.s. |
Generalitat, indirectly administered | -- | -- | 0.684 | −0.146–1.783 | n.s. | n.s. |
Other public institutions, publicly administered | -- | -- | 0.359 | −0.312–1.053 | n.s. | n.s. |
Other institutions, indirectly administered | -- | -- | 0.424 | −0.555–2.615 | n.s. | n.s. |
For-profit, with rented places | -- | -- | 0.282 | −0.293–0.942 | n.s. | n.s. |
Nonprofit, with rented places | -- | -- | 0.445 | −0.317–1.428 | n.s. | n.s. |
Nonprofit, completely privately administered | -- | -- | 0.202 | −0.211–0.626 | n.s. | n.s. |
County population | -- | -- | 0.035 | 0.011–0.058 | 0.033 | 0.010–0.056 |
County CIR/100,000 | -- | -- | 0.250 | 0.173–−0.347 | 0.241 | 0.178–0.330 |
Goodness of fit | Test-1 (1) | Test-2 (2) | ||||
−2 * Log Likelihood | 1177.6 | 1056.7 | 1061.3 | |||
Degrees of freedom | 3 | 11 | 4 | |||
Chi square difference of −2 * log likelihoods | 120.9 * | 4.6 | ||||
Degrees of freedom difference | 8 | 7 |
Part 1. Logistic Regression: Absence of COVID-19 Infection by LTCH Size | ||||||||
---|---|---|---|---|---|---|---|---|
Unadjusted | Adjusted-I | Adjusted-II | Significant Interactions | |||||
Coeff. | 95% CI | Coeff. | 95% CI | Coeff. | 95% CI | Coeff. | 95% CI | |
Intercept | −0.643 | −1.402–−0.153 | 0.897 | 0.034–1.995 | 1.097 | 0.196–1.954 | 1.097 | 0.196–2.121 |
LTCH size | −0.138 | −0.277–0.141 | −0.165 | −0.263–−0.097 | −0.159 | −0.239–−0.107 | −0.159 | −0.239–−0.096 |
LTCH size 2 | −0.021–0.008 | n.s. | n.s. | n.s. | n.s. | n.s. | n.s. | |
LTCH type | ||||||||
For profit, completely privately administered | - | - | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. |
Generalitat, publicly administered | - | - | −0.727 | −12.627–0.799 | n.s. | n.s. | n.s. | n.s. |
Generalitat, indirectly administered | - | - | 0.018 | −1.322–0.780 | n.s. | n.s. | n.s. | n.s. |
Other public institutions, publicly administered | - | - | 0.278 | −0.656–1.064 | n.s. | n.s. | n.s. | n.s. |
Other public institutions, indirectly administered | - | - | 0.499 | −9.201–2.096 | n.s. | n.s. | n.s. | n.s. |
For profit, with rented places | - | - | 0.197 | −0.631–0.918 | n.s. | n.s. | n.s. | n.s. |
Nonprofit, with rented places | - | - | −0.277 | −2.044–0.774 | n.s. | n.s. | n.s. | n.s. |
Nonprofit, completely privately administered | - | - | 0.188 | −0.465–0.804 | n.s. | n.s. | n.s. | n.s. |
County population | - | - | −0.027 | −0.061–0.007 | n.s. | n.s. | n.s. | n.s. |
County CIR/100,000 | - | - | −0.144 | −0.275–−0.040 | −0.2 | −0.302–−0.110 | −0.200 | −0.302–−0.110 |
Part 2: Hurdle negative binomial: Number of COVID-19 deaths by LTCH size | ||||||||
Intercept | 0.271 | −0.118–0.562 | −0.301 | −1.003–0.295 | −0.369 | −1.076–0.102 | 0.626 | −0.475–1.696 |
LTCH size | 0.229 | 0.175–0.313 | 0.208 | 0.148–0.296 | 0.228 | 0.175–0.299 | 0.099 | −0.038–0.227 |
LTCH size 2 | −0.004 | −0.009–−0.002 | −0.003 | −0.008–−0.001 | −0.004 | −0.009–−0.003 | −0.004 | −0.009–0.001 |
LTCH Type | ||||||||
For profit, completely privately administered | - | - | Ref. | Ref. | Ref. | Ref. | Ref. | Ref. |
Generalitat, publicly administered | - | - | 0.422 | −0.202–0.877 | n.s. | n.s. | n.s. | n.s. |
Generalitat, indirectly administered | - | - | 0.23 | −0.122–0.528 | n.s. | n.s. | n.s. | n.s. |
Other public institutions, publicly administered | - | - | 0.085 | −0.358–0.465 | n.s. | n.s. | n.s. | n.s. |
Other public institutions, indirectly administered | - | - | 0.048 | −0.664–0.542 | n.s. | n.s. | n.s. | n.s. |
For profit, with rented places | - | - | −0.236 | −0.626–0.086 | n.s. | n.s. | n.s. | n.s. |
Nonprofit, with rented places | - | - | 0.315 | −0.059–0.617 | n.s. | n.s. | n.s. | n.s. |
Nonprofit, completely privately administered | - | - | 0.119 | −0.259–0.434 | n.s. | n.s. | n.s. | n.s. |
County population | - | - | −0.001 | −0.014–0.013 | n.s. | n.s. | n.s. | n.s. |
County CIR/100,000 | - | - | 0.075 | 0.005–0.149 | 0.078 | 0.019–0.142 | −0.035 | −0.158–0.078 |
Interactions LTCH size | ||||||||
County Population by LTCH size | - | - | - | - | - | - | - | - |
County CIR by LTCH size | - | - | - | - | - | - | 0.014 | 0.004–0.030 |
Interactions LTCH size 2 | ||||||||
Population by LTCH size 2 | - | - | - | - | - | - | - | - |
CIR by LTCH size 2 | - | - | - | - | - | - | - | - |
Dispersion | 1.386 | 1.030–1.877 | 1.228 | 0.884–1.578 | 1.291 | 0.960–1.719 | 1252,000 | 0.927–1.642 |
Goodness of fit | Test-1 (1) | Test-2 (2) | Test-3 (3) | |||||
−2 * Log Likelihood | 3382.1 | 3338.3 | 3352.8 | 3345.2 | ||||
Degrees of freedom | 7 | 24 | 8 | 9 | ||||
Chi squared difference of −2 * log likelihoods | 43.8 * | 14.5 | 7.5 * | |||||
Degrees of freedom difference | 17 | 16 | 1 |
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LTCHs | Number of Residents | |||
---|---|---|---|---|
N | % | N | % | |
Total | 965 | 100% | 56,831 | 100% |
LTCH size | ||||
<30 | 298 | 31% | 6544 | 12% |
30–49 | 201 | 21% | 23,212 | 41% |
50–99 | 329 | 34% | 7665 | 13% |
100–149 | 86 | 9% | 10,198 | 18% |
150–199 | 42 | 4% | 7048 | 12% |
200 and more | 9 | 1% | 2164 | 4% |
County population | ||||
Barcelona | 274 | 28% | 15,477 | 27% |
Between 700,000 and 1,000,000 | 213 | 22% | 11,644 | 20% |
Between 200,000 and 700,000 | 181 | 19% | 11,353 | 20% |
Between 100,000 and 200,000 | 180 | 19% | 11,280 | 20% |
Less than 100,000 inhabitants | 117 | 12% | 7077 | 12% |
County COVID-19 CIR | ||||
Less than 500/100,000 | 214 | 22% | 13,640 | 24% |
Between 500 and 750/100,000 | 154 | 16% | 9386 | 17% |
Between 750 and 900/100,000 | 263 | 27% | 14,639 | 26% |
Between 900 and 1000/100,000 | 283 | 30% | 16,005 | 28% |
More than 1000/1,000,000 | 51 | 5% | 3161 | 6% |
COVID-19 Infection in LTCH | Number of LTCH and % with at Least One COVID-19 Death | COVID-19 Deaths (SD) | |||
---|---|---|---|---|---|
N | % | N | % | Mean (SD) | |
Total | 627 | 65 | 505 | 52 | 7.7 (8.9) |
LTCH size | |||||
<30 | 156 | 52 | 114 | 38 | 3.2 (3.1) |
30–49 | 115 | 57 | 87 | 43 | 4.1 (3.6) |
50–99 | 236 | 72 | 193 | 59 | 7.7 (7.0) |
100–149 | 72 | 84 | 66 | 77 | 11.0 (9.5) |
150–199 | 40 | 95 | 38 | 90 | 19.3 (13.3) |
200 and more | 8 | 89 | 7 | 78 | 30.3 (23.8) |
County population | |||||
Barcelona | 218 | 80 | 31 | 69 | 8.2 (9.5) |
Between 700,000 and 1,000,000 | 153 | 72 | 83 | 59 | 7.4 (7.6) |
Between 200,000 and 700,000 | 90 | 50 | 77 | 42 | 7.5 (9.1) |
Between 100,000 and 200,000 | 118 | 66 | 126 | 46 | 8.1 (9.9) |
Less than 100,000 inhabitants | 48 | 41 | 188 | 26 | 4.9 (6.8) |
County COVID-19 CIR | |||||
Less than 500/100,000 | 94 | 44 | 56 | 26 | 6.6 (8.3) |
Between 500 and 750/100,000 | 83 | 54 | 73 | 46 | 7.1 (8.4) |
Between 750 and 900/100,000 | 182 | 69 | 148 | 56 | 7.2 (7.4) |
Between 900 and 1000/100,000 | 225 | 79 | 192 | 68 | 8.2 (9.5) |
More than 1000/100,000 | 43 | 84 | 36 | 71 | 9.8 (12.5) |
LTCH Type | |||||
Generalitat, publicly administered | 15 | 75 | 14 | 70 | 14.4 (10.9) |
Generalitat, indirectly administered | 33 | 77 | 28 | 65 | 10.0 (6.6) |
Other public institutions, publicly administered | 35 | 58 | 25 | 42 | 8.8 (10.5) |
Other public institutions, indirectly administered | 15 | 79 | 11 | 58 | 7.4 (6.4) |
For-profit, with rented places | 75 | 76 | 63 | 64 | 9.9 (11.8) |
Nonprofit, with rented places | 39 | 81 | 35 | 73 | 11.4 (10.0) |
For-profit, completely privately administered | 322 | 61 | 258 | 49 | 6.2 (7.9) |
Nonprofit, completely privately administered | 93 | 64 | 71 | 49 | 6.6 (7.6) |
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Zunzunegui, M.V.; Béland, F.; Rico, M.; López, F.J.G. Long-Term Care Home Size Association with COVID-19 Infection and Mortality in Catalonia in March and April 2020. Epidemiologia 2022, 3, 369-390. https://doi.org/10.3390/epidemiologia3030029
Zunzunegui MV, Béland F, Rico M, López FJG. Long-Term Care Home Size Association with COVID-19 Infection and Mortality in Catalonia in March and April 2020. Epidemiologia. 2022; 3(3):369-390. https://doi.org/10.3390/epidemiologia3030029
Chicago/Turabian StyleZunzunegui, Maria Victoria, François Béland, Manuel Rico, and Fernando J. García López. 2022. "Long-Term Care Home Size Association with COVID-19 Infection and Mortality in Catalonia in March and April 2020" Epidemiologia 3, no. 3: 369-390. https://doi.org/10.3390/epidemiologia3030029