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Hogan DB, Maxwell CJ, Dampf H, McGrail K, Estabrooks CA, Poss JW, Bakal JA, Hoben M. Excess Deaths in Assisted Living and Nursing Homes during the COVID-19 Pandemic in Alberta, Canada. J Am Med Dir Assoc 2024; 25:105032. [PMID: 38782041 DOI: 10.1016/j.jamda.2024.105032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES Assisted living (AL) is a significant and growing congregate care option for vulnerable older adults designed to reduce the use of nursing homes (NHs). However, work on excess mortality in congregate care during the COVID-19 pandemic has primarily focused on NHs with only a few US studies examining AL. The objective of this study was to assess excess mortality among AL and NH residents with and without dementia or significant cognitive impairment in Alberta, Canada, during the first 2 years of the COVID-19 pandemic, relative to the 3 years before. DESIGN Population-based, retrospective cohort study. SETTING AND PARTICIPANTS Residents who lived in an AL or NH facility operated or contracted by the Provincial health care system to provide publicly funded care in Alberta between January 1, 2017, and December 31, 2021. METHODS We used administrative health care data, including Resident Assessment Instrument - Home Care (RAI-HC, AL) and Minimum Data Set 2.0 (RAI-MDS 2.0, NHs) records, linked with data on residents' vital statistics, COVID-19 testing, emergency room registrations, and hospital stays. The outcome was excess deaths during COVID-19 (ie, the number of deaths beyond that expected based on pre-pandemic data), estimated, using overdispersed Poisson generalized linear models. RESULTS Overall, the risk of excess mortality [adjusted incidence rate ratio (95% confidence interval)] was higher in ALs than in NHs [1.20 (1.14-1.26) vs 1.10 (1.07-1.13)]. Weekly peaks in excess deaths coincided with COVID-19 pandemic waves and were higher among those with diagnosed dementia or significant cognitive impairment in both, AL and NHs. CONCLUSIONS AND IMPLICATIONS Finding excess mortality within both AL and NH facilities should lead to greater focus on infection prevention and control measures across all forms of congregate housing for vulnerable older adults. The specific needs of residents with dementia in particular will have to be addressed.
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Affiliation(s)
- David B Hogan
- Division of Geriatric Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Colleen J Maxwell
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada; ICES, Toronto, Ontario, Canada
| | - Hana Dampf
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Kimberlyn McGrail
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Carole A Estabrooks
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Jeffrey W Poss
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Jeffrey A Bakal
- Provincial Research Data Services, Alberta Health Services, Edmonton, Alberta, Canada; Alberta Strategy for Patient Oriented Research Support Unit, Edmonton, Alberta, Canada
| | - Matthias Hoben
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada; School of Health Policy and Management, Faculty of Health, York University, Toronto, Ontario, Canada.
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Pardo-Garcia I, Martinez-Lacoba R, Moya-Martínez P, Amo-Saus E, del Pozo-Rubio R, Escribano-Sotos F. Mortality risk factors in the dependent population of Castilla-La Mancha (Spain) before and during the first COVID-19 wave. Heliyon 2024; 10:e28931. [PMID: 38617942 PMCID: PMC11015414 DOI: 10.1016/j.heliyon.2024.e28931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/16/2024] Open
Abstract
The coronavirus disease pandemic has had an important impact worldwide. The population aged over 65 years and aged dependent persons are the population groups which have suffered in a highest level the consequences of the pandemic in terms of cases and death. In Spain, the situation is similar to other countries, but regional studies are needed because competencies on long-term care depend on regional public administration. Thus, the aim of this work is to analyse social and individual factors associated with the risk of mortality of legally recognised dependent people during the pandemic compared to a non-pandemic period. The data were extracted from the administrative database on individuals included in Castilla-La Mancha's long-term care system and it was merged with the information from the Spanish National Death Index administered by the Ministry of Health, Consumption and Social Welfare. The results show that the risk of mortality between March and June 2020 was positively associated with being male; being older than 65, with an especially high impact in the group aged over 90; having a higher level of dependency; living in a nursing home; and living in a place with more population density. Intraregional differences related to health areas also exists in both pandemic and non-pandemic periods. These findings are critical with a view to enhancing protocols for the care of the most vulnerable population groups.
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Affiliation(s)
- Isabel Pardo-Garcia
- Facultad de Ciencias Económicas y Empresariales, Universidad de Castilla-La Mancha, Spain
- Departamento de Economía Aplicada I, Universidad de Castilla-La Mancha, Spain
- Centro de Estudios Sociosanitarios (CESS), Universidad de Castilla-La Mancha, Spain
- Grupo de Investigación en Economía, Alimentación y Sociedad (GEAS), Universidad de Castilla-La Mancha, Spain
| | - Roberto Martinez-Lacoba
- Facultad de Ciencias Económicas y Empresariales, Universidad de Castilla-La Mancha, Spain
- Departamento de Análisis Económico y Finanzas, Universidad de Castilla-La Mancha, Spain
- Centro de Estudios Sociosanitarios (CESS), Universidad de Castilla-La Mancha, Spain
- Grupo de Investigación en Economía, Alimentación y Sociedad (GEAS), Universidad de Castilla-La Mancha, Spain
| | - Pablo Moya-Martínez
- Facultad de Ciencias Sociales, Universidad de Castilla-La Mancha, Spain
- Departamento de Análisis Económico y Finanzas, Universidad de Castilla-La Mancha, Spain
- Centro de Estudios Sociosanitarios (CESS), Universidad de Castilla-La Mancha, Spain
- Grupo de Investigación en Economía, Alimentación y Sociedad (GEAS), Universidad de Castilla-La Mancha, Spain
| | - Elisa Amo-Saus
- Facultad de Ciencias Económicas y Empresariales, Universidad de Castilla-La Mancha, Spain
- Departamento de Análisis Económico y Finanzas, Universidad de Castilla-La Mancha, Spain
- Centro de Estudios Sociosanitarios (CESS), Universidad de Castilla-La Mancha, Spain
- Grupo de Investigación en Economía, Alimentación y Sociedad (GEAS), Universidad de Castilla-La Mancha, Spain
| | - Raúl del Pozo-Rubio
- Facultad de Ciencias Sociales, Universidad de Castilla-La Mancha, Spain
- Departamento de Análisis Económico y Finanzas, Universidad de Castilla-La Mancha, Spain
- Centro de Estudios Sociosanitarios (CESS), Universidad de Castilla-La Mancha, Spain
- Grupo de Investigación en Economía, Alimentación y Sociedad (GEAS), Universidad de Castilla-La Mancha, Spain
| | - Francisco Escribano-Sotos
- Facultad de Ciencias Económicas y Empresariales, Universidad de Castilla-La Mancha, Spain
- Departamento de Análisis Económico y Finanzas, Universidad de Castilla-La Mancha, Spain
- Centro de Estudios Sociosanitarios (CESS), Universidad de Castilla-La Mancha, Spain
- Grupo de Investigación en Economía, Alimentación y Sociedad (GEAS), Universidad de Castilla-La Mancha, Spain
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Karimi-Dehkordi M, Hanson HM, Silvius J, Wagg A. Drivers of COVID-19 Outcomes in Long-Term Care Facilities Using Multi-Level Analysis: A Systematic Review. Healthcare (Basel) 2024; 12:807. [PMID: 38610229 PMCID: PMC11011537 DOI: 10.3390/healthcare12070807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/30/2024] [Accepted: 04/05/2024] [Indexed: 04/14/2024] Open
Abstract
This study aimed to identify the individual, organizational, and environmental factors which contributed to COVID-19-related outcomes in long-term care facilities (LTCFs). A systematic review was conducted to summarize and synthesize empirical studies using a multi-level analysis approach to address the identified influential factors. Five databases were searched on 23 May 2023. To be included in the review, studies had to be published in peer-reviewed journals or as grey literature containing relevant statistical data. The Joanna Briggs Institute critical appraisal tool was employed to assess the methodological quality of each article included in this study. Of 2137 citations identified after exclusions, 99 records met the inclusion criteria. The predominant individual, organizational, and environmental factors that were most frequently found associated with the COVID-19 outbreak comprised older age, higher dependency level; lower staffing levels and lower star and subset domain ratings for the facility; and occupancy metrics and co-occurrences of outbreaks in counties and communities where the LTCFs were located, respectively. The primary individual, organizational, and environmental factors frequently linked to COVID-19-related deaths comprised age, and male sex; higher percentages of racial and ethnic minorities in LTCFs, as well as ownership types (including private, for-profit, and chain membership); and higher occupancy metrics and LTCF's size and bed capacity, respectively. Unfolding the risk factors collectively may mitigate the risk of outbreaks and pandemic-related mortality in LTCFs during future endemic and pandemics through developing and improving interventions that address those significant factors.
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Affiliation(s)
- Mehri Karimi-Dehkordi
- Faculty of Medicine & Dentistry, Keyano College, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Heather M. Hanson
- Seniors Health Strategic Clinical Network, Alberta Health Services, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (H.M.H.); (J.S.)
| | - James Silvius
- Seniors Health Strategic Clinical Network, Alberta Health Services, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (H.M.H.); (J.S.)
| | - Adrian Wagg
- Seniors Health Strategic Clinical Network, Alberta Health Services, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada;
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Cases L, Vela E, Santaeugènia Gonzàlez SJ, Contel JC, Carot-Sans G, Coca M, Pastor M, Carrasco I, Barbeta C, Vila A, Amil P, Plaza A, Pontes C, Piera-Jiménez J, Amblàs J. Excess mortality among older adults institutionalized in long-term care facilities during the COVID-19 pandemic: a population-based analysis in Catalonia. Front Public Health 2023; 11:1208184. [PMID: 37732085 PMCID: PMC10507684 DOI: 10.3389/fpubh.2023.1208184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/15/2023] [Indexed: 09/22/2023] Open
Abstract
Objectives To assess excess mortality among older adults institutionalized in nursing homes within the successive waves of the COVID-19 pandemic in Catalonia (north-east Spain). Design Observational, retrospective analysis of population-based central healthcare registries. Setting and participants Individuals aged >65 years admitted in any nursing home in Catalonia between January 1, 2015, and April 1, 2022. Methods Deaths reported during the pre-pandemic period (2015-2019) were used to build a reference model for mortality trends (a Poisson model, due to the event counting nature of the variable "mortality"), adjusted by age, sex, and clinical complexity, defined according to the adjusted morbidity groups. Excess mortality was estimated by comparing the observed and model-based expected mortality during the pandemic period (2020-2022). Besides the crude excess mortality, we estimated the standardized mortality rate (SMR) as the ratio of weekly deaths' number observed to the expected deaths' number over the same period. Results The analysis included 175,497 older adults institutionalized (mean 262 days, SD 132), yielding a total of 394,134 person-years: 288,948 person-years within the reference period (2015-2019) and 105,186 within the COVID-19 period (2020-2022). Excess number of deaths in this population was 5,403 in the first wave and 1,313, 111, -182, 498, and 329 in the successive waves. The first wave on March 2020 showed the highest SMR (2.50; 95% CI 2.45-2.56). The corresponding SMR for the 2nd to 6th waves were 1.31 (1.27-1.34), 1.03 (1.00-1.07), 0.93 (0.89-0.97), 1.13 (1.10-1.17), and 1.07 (1.04-1.09). The number of excess deaths following the first wave ranged from 1,313 (2nd wave) to -182 (4th wave). Excess mortality showed similar trends for men and women. Older adults and those with higher comorbidity burden account for higher number of deaths, albeit lower SMRs. Conclusion Excess mortality analysis suggest a higher death toll of the COVID-19 crisis in nursing homes than in other settings. Although crude mortality rates were far higher among older adults and those at higher health risk, younger individuals showed persistently higher SMR, indicating an important death toll of the COVID-19 in these groups of people.
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Affiliation(s)
- Laia Cases
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic—Central University of Catalonia (UVIC-UCC), Barcelona, Spain
- Sub-Directorate General of Surveillance and Response to Public Health Emergencies, Public Health Agency of Catalonia, Generalitat of Catalonia, Barcelona, Spain
| | - Emili Vela
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3), IDIBELL, Barcelona, Spain
| | - Sebastià J. Santaeugènia Gonzàlez
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic—Central University of Catalonia (UVIC-UCC), Barcelona, Spain
- General Directorate of Health and Research Planning, Department of Health, Generalitat de Catalunya, Barcelona, Spain
| | - Joan Carles Contel
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic—Central University of Catalonia (UVIC-UCC), Barcelona, Spain
- General Directorate of Health and Research Planning, Department of Health, Generalitat de Catalunya, Barcelona, Spain
- Integrated Social and Health Care Program, Generalitat de Catalunya, Barcelona, Spain
| | - Gerard Carot-Sans
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3), IDIBELL, Barcelona, Spain
| | - Marc Coca
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3), IDIBELL, Barcelona, Spain
| | - Marta Pastor
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3), IDIBELL, Barcelona, Spain
| | - Ignasi Carrasco
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic—Central University of Catalonia (UVIC-UCC), Barcelona, Spain
- Catalan Health Service, Barcelona, Spain
| | - Conxita Barbeta
- Integrated Social and Health Care Program, Generalitat de Catalunya, Barcelona, Spain
- Department of Social Welfare, Generalitat de Catalunya, Barcelona, Spain
| | - Anna Vila
- Integrated Social and Health Care Program, Generalitat de Catalunya, Barcelona, Spain
- Department of Social Welfare, Generalitat de Catalunya, Barcelona, Spain
| | - Paloma Amil
- General Directorate of Health and Research Planning, Department of Health, Generalitat de Catalunya, Barcelona, Spain
- Integrated Social and Health Care Program, Generalitat de Catalunya, Barcelona, Spain
| | - Aina Plaza
- General Directorate of Health and Research Planning, Department of Health, Generalitat de Catalunya, Barcelona, Spain
- Integrated Social and Health Care Program, Generalitat de Catalunya, Barcelona, Spain
| | - Caridad Pontes
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3), IDIBELL, Barcelona, Spain
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Piera-Jiménez
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3), IDIBELL, Barcelona, Spain
- Faculty of Informatics, Multimedia and Telecommunications, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Jordi Amblàs
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic—Central University of Catalonia (UVIC-UCC), Barcelona, Spain
- General Directorate of Health and Research Planning, Department of Health, Generalitat de Catalunya, Barcelona, Spain
- Integrated Social and Health Care Program, Generalitat de Catalunya, Barcelona, Spain
- Faculty of Medicine, University of Vic-Central University of Catalonia, Vic, Spain
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Cuypers L, Keyaerts E, Hong SL, Gorissen S, Menezes SM, Starick M, Van Elslande J, Weemaes M, Wawina-Bokalanga T, Marti-Carreras J, Vanmechelen B, Van Holm B, Bloemen M, Dogne JM, Dufrasne F, Durkin K, Ruelle J, De Mendonca R, Wollants E, Vermeersch P, Boulouffe C, Djiena A, Broucke C, Catry B, Lagrou K, Van Ranst M, Neyts J, Baele G, Maes P, André E, Dellicour S, Van Weyenbergh J. Immunovirological and environmental screening reveals actionable risk factors for fatal COVID-19 during post-vaccination nursing home outbreaks. NATURE AGING 2023:10.1038/s43587-023-00421-1. [PMID: 37217661 DOI: 10.1038/s43587-023-00421-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 04/13/2023] [Indexed: 05/24/2023]
Abstract
Coronavirus Disease 2019 (COVID-19) vaccination has resulted in excellent protection against fatal disease, including in older adults. However, risk factors for post-vaccination fatal COVID-19 are largely unknown. We comprehensively studied three large nursing home outbreaks (20-35% fatal cases among residents) by combining severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) aerosol monitoring, whole-genome phylogenetic analysis and immunovirological profiling of nasal mucosa by digital nCounter transcriptomics. Phylogenetic investigations indicated that each outbreak stemmed from a single introduction event, although with different variants (Delta, Gamma and Mu). SARS-CoV-2 was detected in aerosol samples up to 52 d after the initial infection. Combining demographic, immune and viral parameters, the best predictive models for mortality comprised IFNB1 or age, viral ORF7a and ACE2 receptor transcripts. Comparison with published pre-vaccine fatal COVID-19 transcriptomic and genomic signatures uncovered a unique IRF3 low/IRF7 high immune signature in post-vaccine fatal COVID-19 outbreaks. A multi-layered strategy, including environmental sampling, immunomonitoring and early antiviral therapy, should be considered to prevent post-vaccination COVID-19 mortality in nursing homes.
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Affiliation(s)
- Lize Cuypers
- Department of Laboratory Medicine, National Reference Centre for Respiratory Pathogens, University Hospitals Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical Microbiology, KU Leuven, Leuven, Belgium
| | - Els Keyaerts
- Department of Laboratory Medicine, National Reference Centre for Respiratory Pathogens, University Hospitals Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical Microbiology, KU Leuven, Leuven, Belgium
| | - Samuel Leandro Hong
- Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical and Epidemiological Virology, Rega Institute, KU Leuven, Leuven, Belgium
| | - Sarah Gorissen
- Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical Microbiology, KU Leuven, Leuven, Belgium
| | - Soraya Maria Menezes
- Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical and Epidemiological Virology, Rega Institute, KU Leuven, Leuven, Belgium
| | - Marick Starick
- Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical and Epidemiological Virology, Rega Institute, KU Leuven, Leuven, Belgium
| | - Jan Van Elslande
- Department of Laboratory Medicine, National Reference Centre for Respiratory Pathogens, University Hospitals Leuven, Leuven, Belgium
| | - Matthias Weemaes
- Department of Laboratory Medicine, National Reference Centre for Respiratory Pathogens, University Hospitals Leuven, Leuven, Belgium
| | - Tony Wawina-Bokalanga
- Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical and Epidemiological Virology, Rega Institute, KU Leuven, Leuven, Belgium
| | - Joan Marti-Carreras
- Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical and Epidemiological Virology, Rega Institute, KU Leuven, Leuven, Belgium
| | - Bert Vanmechelen
- Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical and Epidemiological Virology, Rega Institute, KU Leuven, Leuven, Belgium
| | - Bram Van Holm
- Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical and Epidemiological Virology, Rega Institute, KU Leuven, Leuven, Belgium
| | - Mandy Bloemen
- Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical and Epidemiological Virology, Rega Institute, KU Leuven, Leuven, Belgium
| | - Jean-Michel Dogne
- Department of Pharmacy, Namur Research Institute for Life Sciences, University of Namur, Namur, Belgium
| | - François Dufrasne
- Laboratory of Proteomics and Microbiology, University of Mons, Mons, Belgium
- Department of Infectious Diseases, Laboratory of Viral Diseases, National Institute for Public Health (Sciensano), Brussels, Belgium
| | - Keith Durkin
- Laboratory of Human Genetics, GIGA Research Institute, Liège, Belgium
| | - Jean Ruelle
- Medical Microbiology Unit (MBLG), Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium
| | | | - Elke Wollants
- Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical and Epidemiological Virology, Rega Institute, KU Leuven, Leuven, Belgium
| | - Pieter Vermeersch
- Department of Laboratory Medicine, National Reference Centre for Respiratory Pathogens, University Hospitals Leuven, Leuven, Belgium
| | - Caroline Boulouffe
- Infectious Disease Surveillance Unit, Agence pour une vie de qualité (AVIQ), Wallonia, Belgium
| | - Achille Djiena
- Infectious Disease Surveillance Unit, Agence pour une vie de qualité (AVIQ), Wallonia, Belgium
| | - Caroline Broucke
- Outbreak Investigation Team, Agentschap zorg en gezondheid, Flanders, Belgium
| | - Boudewijn Catry
- Unit Healthcare-Associated Infections and Antimicrobial Resistance, Sciensano, Brussels, Belgium
| | - Katrien Lagrou
- Department of Laboratory Medicine, National Reference Centre for Respiratory Pathogens, University Hospitals Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical Microbiology, KU Leuven, Leuven, Belgium
| | - Marc Van Ranst
- Department of Laboratory Medicine, National Reference Centre for Respiratory Pathogens, University Hospitals Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical and Epidemiological Virology, Rega Institute, KU Leuven, Leuven, Belgium
| | - Johan Neyts
- Department of Microbiology, Immunology and Transplantation, Laboratory Virology and Chemotherapy, Rega Institute, KU Leuven, Leuven, Belgium
| | - Guy Baele
- Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical and Epidemiological Virology, Rega Institute, KU Leuven, Leuven, Belgium
| | - Piet Maes
- Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical and Epidemiological Virology, Rega Institute, KU Leuven, Leuven, Belgium
| | - Emmanuel André
- Department of Laboratory Medicine, National Reference Centre for Respiratory Pathogens, University Hospitals Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical Microbiology, KU Leuven, Leuven, Belgium
| | - Simon Dellicour
- Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical and Epidemiological Virology, Rega Institute, KU Leuven, Leuven, Belgium
- Spatial Epidemiology Lab (SpELL), Université Libre de Bruxelles, Bruxelles, Belgium
| | - Johan Van Weyenbergh
- Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical and Epidemiological Virology, Rega Institute, KU Leuven, Leuven, Belgium.
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Scanferla G, Héquet D, Graf N, Münzer T, Kessler S, Kohler P, Nussbaumer A, Petignat C, Schlegel M, Flury D. COVID-19 burden and influencing factors in Swiss long-term-care facilities: a cross-sectional analysis of a multicentre observational cohort. Swiss Med Wkly 2023; 153:40052. [PMID: 37011609 DOI: 10.57187/smw.2023.40052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
OBJECTIVES: To describe the burden of COVID-19 in Swiss long-term care facilities in 2020, to identify its influencing factors, and to assess vaccination rates among residents and healthcare workers at the end of the vaccine campaign in Switzerland in May 2021.
DESIGN: Cross-sectional survey.
SETTING AND PARTICIPANTS: Long-term care facilities from two Swiss cantons (St. Gallen / Eastern Switzerland and Vaud / Western Switzerland).
METHODS: We collected numbers of COVID-19 cases and related deaths and all-cause mortality for 2020, potential risk factors at the institutional level (e.g. size, infection prevention and control measures, and resident characteristics), and vaccination rates among residents and healthcare workers. Univariate and multivariate analyses were used to identify factors associated with resident mortality in 2020.
RESULTS: We enrolled 59 long-term care facilities with a median of 46 (interquartile range [IQR]: 33–69) occupied beds. In 2020, the median COVID-19 incidence was 40.2 (IQR: 0–108.6) per 100 occupied beds, with higher rates in VD (49.9%) than in SG (32.5%; p = 0.037). Overall, 22.7% of COVID-19 cases died, of which 24.8% were COVID-19-related deaths. In the univariate analysis, higher resident mortality was associated with COVID-19 rates among residents (p < 0.001) and healthcare workers (p = 0.002) and age (p = 0.013). Lower resident mortality was associated with the proportion of single rooms (p = 0.012), isolation of residents with COVID-19 in single rooms (p = 0.003), symptom screening of healthcare workers (p = 0.031), limiting the number of visits per day (p = 0.004), and pre-scheduling visits (p = 0.037). In the multivariate analysis, higher resident mortality was only associated with age (p = 0.03) and the COVID-19 rate among residents (p = 0.013). Among 2936 residents, 2042 (69.9%) received ≥1 dose of the COVID-19 vaccine before 31 May 2021. Vaccine uptake among healthcare workers was 33.8%.
CONCLUSION AND IMPLICATIONS: COVID-19 burden was high but also highly variable in Swiss long-term care facilities. severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among healthcare workers was a modifiable factor associated with increased resident mortality. Symptom screening of healthcare workers appeared to be an effective preventive strategy and should be included in routine infection prevention and control measures. Promoting COVID-19 vaccine uptake among healthcare workers should be a priority in Swiss long-term care facilities.
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Affiliation(s)
- Giulia Scanferla
- Department of Infectious Diseases/Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Delphine Héquet
- Unité cantonale hygiène, prévention et contrôle de l'infection, Canton de Vaud, Switzerland
| | - Nicole Graf
- Clinical Trials Unit (CTU), Cantonal Hospital St Gallen, St Gallen, Switzerland
| | | | - Simone Kessler
- Department of Infectious Diseases/Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Philipp Kohler
- Department of Infectious Diseases/Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Andres Nussbaumer
- Department of Infectious Diseases/Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Christiane Petignat
- Department of Infectious Diseases/Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Matthias Schlegel
- Department of Infectious Diseases/Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Domenica Flury
- Department of Infectious Diseases/Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
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Coker ES, Molitor J, Liverani S, Martin J, Maranzano P, Pontarollo N, Vergalli S. Bayesian profile regression to study the ecologic associations of correlated environmental exposures with excess mortality risk during the first year of the Covid-19 epidemic in lombardy, Italy. ENVIRONMENTAL RESEARCH 2023; 216:114484. [PMID: 36220446 PMCID: PMC9547389 DOI: 10.1016/j.envres.2022.114484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/23/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
Many countries, including Italy, have experienced significant social and spatial inequalities in mortality during the Covid-19 pandemic. This study applies a multiple exposures framework to investigate how joint place-based factors influence spatial inequalities of excess mortality during the first year of the Covid -19 pandemic in the Lombardy region of Italy. For the Lombardy region, we integrated municipality-level data on all-cause mortality between 2015 and 2020 with 13 spatial covariates, including 5-year average concentrations of six air pollutants, the average temperature in 2020, and multiple socio-demographic factors, and health facilities per capita. Using the clustering algorithm Bayesian profile regression, we fit spatial covariates jointly to identify clusters of municipalities with similar exposure profiles and estimated associations between clusters and excess mortality in 2020. Cluster analysis resulted in 13 clusters. Controlling for spatial autocorrelation of excess mortality and health-protective agency, two clusters had significantly elevated excess mortality than the rest of Lombardy. Municipalities in these highest-risk clusters are in Bergamo, Brescia, and Cremona provinces. The highest risk cluster (C11) had the highest long-term particulate matter air pollution levels (PM2.5 and PM10) and significantly elevated NO2 and CO air pollutants, temperature, proportion ≤18 years, and male-to-female ratio. This cluster is significantly lower for income and ≥65 years. The other high-risk cluster, Cluster 10 (C10), is elevated significantly for ozone but significantly lower for other air pollutants. Covariates with elevated levels for C10 include proportion 65 years or older and a male-to-female ratio. Cluster 10 is significantly lower for income, temperature, per capita health facilities, ≤18 years, and population density. Our results suggest that joint built, natural, and socio-demographic factors influenced spatial inequalities of excess mortality in Lombardy in 2020. Studies must apply a multiple exposures framework to guide policy decisions addressing the complex and multi-dimensional nature of spatial inequalities of Covid-19-related mortality.
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Affiliation(s)
- Eric S Coker
- Department of Environmental and Global Health, University of Florida, 1225 Center Dr, Gainesville, FL, 32610, United States.
| | - John Molitor
- College of Public Health and Human Sciences, Oregon State University, Milam Hall 157, 2520 SW Campus Way, Corvallis, OR, 97331, United States.
| | - Silvia Liverani
- School of Mathematical Sciences, Queen Mary University of London, Mile End Road London E1 4NS, United Kingdom.
| | - James Martin
- Department of Environmental and Global Health, University of Florida, 1225 Center Dr, Gainesville, FL, 32610, United States
| | - Paolo Maranzano
- Department of Economics, Management and Statistics of the University of Milano-Bicocca (UniMiB), Piazza Dell'Ateneo Nuovo, 1 - 20126, Milano, Italy.
| | - Nicola Pontarollo
- Department of Economics and Management, Università Degli Studi di Brescia, Brescia, Via S. Faustino 74/B, 25122, Brescia, Italy.
| | - Sergio Vergalli
- Department of Agricultural Economics, Università Cattolica Del Sacro Cuore, Piacenza, Via Emilia Parmense, 29122, Piacenza PC, Italy.
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Epidemiological and Genomic Analysis of a Large SARS-CoV-2 Outbreak in a Long-Term Care Facility in Catalonia, Spain. mSphere 2022; 7:e0034622. [PMID: 36448779 PMCID: PMC9769531 DOI: 10.1128/msphere.00346-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Limiting outbreaks in long-term care facilities (LTCFs) is a cornerstone strategy to avoid an excess of COVID-19-related morbidity and mortality and to reduce its burden on the health system. We studied a large outbreak that occurred at an LTCF, combining methods of classical and genomic epidemiology analysis. The outbreak lasted for 31 days among residents, with an attack rate of 98% and 57% among residents and staff, respectively. The case fatality rate among residents was 16% (n = 15). Phylogenetic analysis of 59 SARS-CoV-2 isolates revealed the presence of two closely related viral variants in all cases (B.1.177 lineage), revealing a far more complex outbreak than initially thought and suggesting an initial spread driven by staff members. In turn, our results suggest that resident relocations to mitigate viral spread might have increased the risk of infection for staff members, creating secondary chains of transmission that were responsible for prolonging the outbreak. Our results highlight the importance of considering unnoticed chains of transmission early during an outbreak and making an adequate use and interpretation of diagnostic tests. Outbreak containment measures should be carefully tailored to each LTCF. IMPORTANCE The impact of COVID-19 on long-term care facilities (LTCFs) has been disproportionately large due to the high frailty of the residents. Here, we report epidemiological and genomic findings of a large outbreak that occurred at an LTCF, which ultimately affected almost all residents and nearly half of staff members. We found that the outbreak was initially driven by staff members; however, later resident relocation to limit the outbreak resulted in transmission from residents to staff members, evidencing the complexity and different phases of the outbreak. The phylogenetic analysis of SARS-CoV-2 isolates indicated that two closely related variants were responsible for the large outbreak. Our study highlights the importance of combining methods of classical and genomic epidemiology to take appropriate outbreak containment measures in LTCFs.
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Mozota M, Castro I, Gómez-Torres N, Arroyo R, Gutiérrez-Díaz I, Delgado S, Rodríguez JM, Alba C. Administration of Ligilactobacillus salivarius CECT 30632 to elderly during the COVID-19 pandemic: Nasal and fecal metataxonomic analysis and fatty acid profiling. Front Microbiol 2022; 13:1052675. [PMID: 36590434 PMCID: PMC9800801 DOI: 10.3389/fmicb.2022.1052675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
Elderly was the most affected population during the first COVID-19 and those living in nursing homes represented the most vulnerable group, with high mortality rates, until vaccines became available. In a previous article, we presented an open-label trial showing the beneficial effect of the strain Ligilactobacillus salivarius CECT 30632 (previously known as L. salivarius MP101) on the functional and nutritional status, and on the nasal and fecal inflammatory profiles of elderly residing in a nursing home highly affected by the pandemic. The objective of this post-hoc analysis was to elucidate if there were changes in the nasal and fecal bacteriomes of a subset of these patients as a result of the administration of the strain for 4 months and, also, its impact on their fecal fatty acids profiles. Culture-based methods showed that, while L. salivarius (species level) could not be detected in any of the fecal samples at day 0, L. salivarius CECT 30632 (strain level) was present in all the recruited people at day 120. Paradoxically, the increase in the L. salivarius counts was not reflected in changes in the metataxonomic analysis of the nasal and fecal samples or in changes in the fatty acid profiles in the fecal samples of the recruited people. Overall, our results indicate that L. salivarius CECT 30632 colonized, at least temporarily, the intestinal tract of the recruited elderly and may have contributed to improvements in their functional, nutritional, and immunological status, without changing the general structure of their nasal and fecal bacteriomes when assessed at the genus level. They also suggest the ability of low abundance bacteria to train immunity.
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Affiliation(s)
- Marta Mozota
- Department of Nutrition and Food Science, Complutense University of Madrid, Madrid, Spain
| | - Irma Castro
- Department of Nutrition and Food Science, Complutense University of Madrid, Madrid, Spain
| | - Natalia Gómez-Torres
- Department of Nutrition and Food Science, Complutense University of Madrid, Madrid, Spain
| | - Rebeca Arroyo
- Department of Nutrition and Food Science, Complutense University of Madrid, Madrid, Spain
| | - Isabel Gutiérrez-Díaz
- Department of Microbiology and Biochemistry, Dairy Research Institute of Asturias (IPLA-CSIC), Villaviciosa, Spain
| | - Susana Delgado
- Department of Microbiology and Biochemistry, Dairy Research Institute of Asturias (IPLA-CSIC), Villaviciosa, Spain
| | - Juan Miguel Rodríguez
- Department of Nutrition and Food Science, Complutense University of Madrid, Madrid, Spain,*Correspondence: Juan Miguel Rodríguez,
| | - Claudio Alba
- Department of Nutrition and Food Science, Complutense University of Madrid, Madrid, Spain,Claudio Alba,
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10
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Dujmovic M, Roederer T, Frison S, Melki C, Lauvin T, Grellety E. COVID-19 in French nursing homes during the second pandemic wave: a mixed-methods cross-sectional study. BMJ Open 2022; 12:e060276. [PMID: 36127110 PMCID: PMC9490301 DOI: 10.1136/bmjopen-2021-060276] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION French nursing homes were deeply affected by the first wave of the COVID-19 pandemic, with 38% of all residents infected and 5% dying. Yet, little was done to prepare these facilities for the second pandemic wave, and subsequent outbreak response strategies largely duplicated what had been done in the spring of 2020, regardless of the unique needs of the care home environment. METHODS A cross-sectional, mixed-methods study using a retrospective, quantitative data from residents of 14 nursing homes between November 2020 and mid-January 2021. Four facilities were purposively selected as qualitative study sites for additional in-person, in-depth interviews in January and February 2021. RESULTS The average attack rate in the 14 participating nursing facilities was 39% among staff and 61% among residents. One-fifth (20) of infected residents ultimately died from COVID-19 and its complications. Failure to thrive syndrome (FTTS) was diagnosed in 23% of COVID-19-positive residents. Those at highest risk of death were men (HR=1.78; 95% CI: 1.18 to 2.70; p=0.006), with FTTS (HR=4.04; 95% CI: 1.93 to 8.48; p<0.001) or in facilities with delayed implementation of universal FFP2 masking policies (HR=1.05; 95% CI: 1.02 to 1.07; p<0.001). The lowest mortality was found in residents of facilities with a partial (HR=0.30; 95% CI: 0.18 to 0.51; p<0.001) or full-time physician on staff (HR=0.20; 95% CI: 0.08 to 0.53; p=0.001). Significant themes emerging from qualitative analysis centred on (1) the structural, chronic neglect of nursing homes, (2) the negative effects of the top-down, bureaucratic nature of COVID-19 crisis response, and (3) the counterproductive effects of lockdowns on both residents and staff. CONCLUSION Despite high resident mortality during the first pandemic wave, French nursing homes were ill-prepared for the second, with risk factors (especially staffing, lack of medical support, isolation/quarantine policy, etc) that affected case fatality and residents' and caregivers' overall well-being and mental health.
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Affiliation(s)
- Morgane Dujmovic
- Department of Epidemiology and Training, Epicentre, Paris, France
| | - Thomas Roederer
- Department of Epidemiology and Training, Epicentre, Paris, France
| | - Severine Frison
- Department of Epidemiology and Training, Epicentre, Paris, France
| | - Carla Melki
- Emergency Cell, Médecins Sans Frontières, Paris, France
| | - Thomas Lauvin
- Emergency Cell, Médecins Sans Frontières, Paris, France
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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. EPIDEMIOLGIA (BASEL, SWITZERLAND) 2022; 3:369-390. [PMID: 36417245 PMCID: PMC9620903 DOI: 10.3390/epidemiologia3030029] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/26/2022] [Accepted: 08/29/2022] [Indexed: 12/14/2022]
Abstract
We aim to assess how COVID-19 infection and mortality varied according to facility size in 965 long-term care homes (LTCHs) in Catalonia during March and April 2020. We measured LTCH size by the number of authorised beds. Outcomes were COVID-19 infection (at least one COVID-19 case in an LTCH) and COVID-19 mortality. Risks of these were estimated with logistic regression and hurdle models. Models were adjusted for county COVID-19 incidence and population, and LTCH types. Sixty-five per cent of the LTCHs were infected by COVID-19. We found a strong association between COVID-19 infection and LTCH size in the adjusted analysis (from 45% in 10-bed homes to 97.5% in those with over 150 places). The average COVID-19 mortality in all LTCHs was 6.8% (3887 deaths) and 9.2% among the COVID-19-infected LTCHs. Very small and large homes had higher COVID-19 mortality, whereas LTCHs with 30 to 70 places had the lowest level. COVID-19 mortality sharply increased with LTCH size in counties with a cumulative incidence of COVID-19 which was higher than 250/100,000, except for very small homes, but slightly decreased with LTCH size when the cumulative incidence of COVID-19 was lower. To prevent infection and preserve life, the optimal size of an LTCH should be between 30 and 70 places.
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Affiliation(s)
- Maria Victoria Zunzunegui
- École de Santé Publique, Université de Montréal, Montreal, QC H3N 1X9, Canada
- Correspondence: ; Tel.: +34-692-064-134
| | - François Béland
- École de Santé Publique, Université de Montréal, Montreal, QC H3N 1X9, Canada
- Institut Lady Davis, Montreal Jewish Hospital, McGill University, Montreal, QC H3C 3J7, Canada
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12
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Aguilar-Palacio I, Maldonado L, Marcos-Campos I, Castel-Feced S, Malo S, Aibar C, Rabanaque M. Understanding the COVID-19 Pandemic in Nursing Homes (Aragón, Spain): Sociodemographic and Clinical Factors Associated With Hospitalization and Mortality. Front Public Health 2022; 10:928174. [PMID: 35875036 PMCID: PMC9301241 DOI: 10.3389/fpubh.2022.928174] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/07/2022] [Indexed: 11/29/2022] Open
Abstract
Old people residing in nursing homes have been a vulnerable group to the coronavirus disease 2019 (COVID-19) pandemic, with high rates of infection and death. Our objective was to describe the profile of institutionalized patients with a confirmed COVID-19 infection and the socioeconomic and morbidity factors associated with hospitalization and death. We conducted a retrospective cohort study including data from subjects aged 65 years or older residing in a nursing home with a confirmed COVID-19 infection from March 2020 to March 2021 (4,632 individuals) in Aragón (Spain). We analyzed their sociodemographic and clinical profiles and factors related to hospitalization and mortality at 7, 30, and 90 days of COVID-19 diagnosis using logistic regression analyses. We found that the risk of hospitalization and mortality varied according to sociodemographic and morbidity profile. There were inequalities in hospitalization by socioeconomic status and gender. Patients with low contributory pensions and women had a lower risk of hospitalization. Diabetes mellitus, heart failure, and chronic kidney disease were associated with a higher risk of hospitalization. On the contrary, people with dementia showed the highest risk of mortality with no hospitalization. Patient-specific factors must be considered to develop equitable and effective measures in nursing homes to be prepared for future health threats.
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Affiliation(s)
- Isabel Aguilar-Palacio
- Preventive Medicine and Public Health Department, University of Zaragoza, Zaragoza, Spain
- Instituto de Investigación Sanitaria de Aragón, Instituto de Investigación Sanitaria de Aragón (IIS), Zaragoza, Spain
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Instituto de Investigación Sanitaria de Aragón (IIS), Zaragoza, Spain
- *Correspondence: Isabel Aguilar-Palacio
| | - Lina Maldonado
- Instituto de Investigación Sanitaria de Aragón, Instituto de Investigación Sanitaria de Aragón (IIS), Zaragoza, Spain
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Instituto de Investigación Sanitaria de Aragón (IIS), Zaragoza, Spain
- Department of Applied Economics, Economic History and Public Economics, University of Zaragoza, Zaragoza, Spain
| | - Iván Marcos-Campos
- Instituto de Investigación Sanitaria de Aragón, Instituto de Investigación Sanitaria de Aragón (IIS), Zaragoza, Spain
| | - Sara Castel-Feced
- Preventive Medicine and Public Health Department, University of Zaragoza, Zaragoza, Spain
- Instituto de Investigación Sanitaria de Aragón, Instituto de Investigación Sanitaria de Aragón (IIS), Zaragoza, Spain
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Instituto de Investigación Sanitaria de Aragón (IIS), Zaragoza, Spain
| | - Sara Malo
- Preventive Medicine and Public Health Department, University of Zaragoza, Zaragoza, Spain
- Instituto de Investigación Sanitaria de Aragón, Instituto de Investigación Sanitaria de Aragón (IIS), Zaragoza, Spain
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Instituto de Investigación Sanitaria de Aragón (IIS), Zaragoza, Spain
| | - Carlos Aibar
- Preventive Medicine and Public Health Department, University of Zaragoza, Zaragoza, Spain
- Instituto de Investigación Sanitaria de Aragón, Instituto de Investigación Sanitaria de Aragón (IIS), Zaragoza, Spain
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Instituto de Investigación Sanitaria de Aragón (IIS), Zaragoza, Spain
| | - MªJosé Rabanaque
- Preventive Medicine and Public Health Department, University of Zaragoza, Zaragoza, Spain
- Instituto de Investigación Sanitaria de Aragón, Instituto de Investigación Sanitaria de Aragón (IIS), Zaragoza, Spain
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Instituto de Investigación Sanitaria de Aragón (IIS), Zaragoza, Spain
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13
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The Impact of Long-Term Care Home Ownership and Administration Type on All-Cause Mortality from March to April 2020 in Madrid, Spain. EPIDEMIOLGIA (BASEL, SWITZERLAND) 2022; 3:323-336. [PMID: 36417241 PMCID: PMC9620910 DOI: 10.3390/epidemiologia3030025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 12/14/2022]
Abstract
Our aim is to assess whether long-term care home (LTCH) ownership and administration type were associated with all-cause mortality in 470 LTCHs in the Community of Madrid (Spain) during March and April 2020, the first two months of the COVID-19 pandemic. There are eight categories of LTCH type, including various combinations of ownership type (for-profit, nonprofit, and public) and administration type (completely private, private with places rented by the public sector, administrative management by procurement, and completely public). Multilevel regression was used to examine the association between mortality and LTCH type, adjusting for LTCH size, the spread of the COVID-19 infection, and the referral hospital. There were 9468 deaths, a mortality rate of 18.3%. Public and private LTCHs had lower mortality than LTCHs under public-private partnership (PPP) agreements. In the fully adjusted model, mortality was 7.4% (95% CI, 3.1-11.7%) in totally public LTCHs compared with 21.9% (95% CI, 17.4-26.4%) in LTCHs which were publicly owned with administrative management by procurement. These results are a testimony to the fatal consequences that pre-pandemic public-private partnerships in long-term residential care led to during the first months of the COVID-19 pandemic in the Community of Madrid, Spain.
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14
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Torres ML, Palma Díaz D, Oliver-Parra A, Millet JP, Cosialls D, Guillaumes M, Rius C, Vásquez-Vera H. Inequities in the incidence and mortality due to COVID-19 in nursing homes in Barcelona by characteristics of the nursing homes. PLoS One 2022; 17:e0269639. [PMID: 35696404 PMCID: PMC9191699 DOI: 10.1371/journal.pone.0269639] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 05/24/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Residents of Nursing Homes (NHs) have suffered greater impacts from the COVID-19 pandemic. However, the rates of COVID-19 in these institutions are heterogeneously distributed. Describing and understanding the structural, functional, and socioeconomic differences between NHs is extremely important to avoid new outbreaks.
Objectives
Analyze inequalities in the cumulative incidences (CIs) and in the mortality rates (MRs) due to COVID-19 in the NHs of Barcelona based on the characteristics of the NHs.
Methods
Exploratory ecological study of 232 NHs. The dependent variables were the cumulative incidence and mortality rate due to COVID-19 in NHs between March and June 2020. Structural variables of the NHs were evaluated such as neighborhood socioeconomic position (SEP), isolation and sectorization capacity, occupancy, overcrowding and ownership.
Results
The cumulative incidence and mortality rate were higher in the low SEP neighborhoods and lower in those of high SEP neighborhoods. Regarding the isolation and sectorization capacity, Type B NHs had a higher risk of becoming infected and dying, while Type C had a lower risk of dying than Type A. Greater overcrowding was associated with greater morbidity and mortality, and higher occupancy was associated with higher incidence. The risk of becoming infected and dying in public NHs was significantly higher than for-profit NH.
Conclusions
The social components together with the functional and infrastructure characteristics of the NHs influence the cumulative incidence and the mortality rate by COVID-19. It is necessary to redefine the care model in the NHs to guarantee the health of the residents.
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Affiliation(s)
- Mayara Louise Torres
- Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
- Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - David Palma Díaz
- Servei d’Epidemiologia, Agència de Salut Pùblica de Barcelona, Barcelona, Catalonia, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Alba Oliver-Parra
- Consorci Sanitari de Barcelona, Barcelona, Catalonia, Spain
- Oficina de Residències de Barcelona, Barcelona, Catalonia, Spain
| | - Joan-Pau Millet
- Servei d’Epidemiologia, Agència de Salut Pùblica de Barcelona, Barcelona, Catalonia, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- * E-mail:
| | - Delfí Cosialls
- Consorci Sanitari de Barcelona, Barcelona, Catalonia, Spain
- Oficina de Residències de Barcelona, Barcelona, Catalonia, Spain
| | - Montserrat Guillaumes
- Servei d’Epidemiologia, Agència de Salut Pùblica de Barcelona, Barcelona, Catalonia, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Cristina Rius
- Servei d’Epidemiologia, Agència de Salut Pùblica de Barcelona, Barcelona, Catalonia, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Hugo Vásquez-Vera
- Servei d’Epidemiologia, Agència de Salut Pùblica de Barcelona, Barcelona, Catalonia, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Ngamprasertchai T, Vanaporn M, Muangnoicharoen S, Pan-ngum W, Ruenroengbun N, Piroonamornpun P, Ponam T, Duangdee C, Chankete P, Jitmuang A, Thamlikitkul V. Mortality in Thai Nursing Homes Based on Antimicrobial-Resistant Enterobacterales Carriage and COVID-19 Lockdown Timing: A Prospective Cohort Study. Antibiotics (Basel) 2022; 11:antibiotics11060762. [PMID: 35740168 PMCID: PMC9219865 DOI: 10.3390/antibiotics11060762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 05/25/2022] [Accepted: 05/30/2022] [Indexed: 12/10/2022] Open
Abstract
Antimicrobial-resistant Enterobacterales carriage and the coronavirus disease 2019 (COVID-19) lockdown measures may impact the incidence all-cause mortality rate among nursing home residents. To determine the all-cause mortality rate in the presence/absence of antimicrobial-resistant Enterobacterales carriage and the incidence all-cause mortality rate before and during COVID-19 pandemic lockdown, this prospective closed-cohort study was conducted at various types of nursing homes in Bangkok, Thailand, from June 2020 to December 2021. The elderly residents included 142 participants (aged ≥60 years) living in nursing homes ≥3 months, who did not have terminal illnesses. Time-to-event analyses with Cox proportional hazards models and stratified log-rank tests were used. The all-cause mortality rate was 18%, and the incidence all-cause mortality rate was 0.59/1000 person-days in residents who had antimicrobial-resistant Enterobacterales carriage at baseline. Meanwhile, the incidence all-cause mortality rate among noncarriage was 0.17/1000 person-days. The mortality incidence rate of carriage was three times higher than residents who were noncarriage without statistical significance (HR 3.2; 95% CI 0.74, 13.83). Residents in nonprofit nursing homes had a higher mortality rate than those in for-profit nursing homes (OR 9.24; 95% CI 2.14, 39.86). The incidence mortality rate during and before lockdown were 0.62 and 0.30, respectively. Effective infection-control policies akin to hospital-based systems should be endorsed in all types of nursing homes. To limit the interruption of long-term chronic care, COVID-19 prevention should be individualized to nursing homes.
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Affiliation(s)
- Thundon Ngamprasertchai
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand;
- Correspondence:
| | - Muthita Vanaporn
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand; (M.V.); (P.C.)
| | - Sant Muangnoicharoen
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand;
| | - Wirichada Pan-ngum
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand;
| | - Narisa Ruenroengbun
- Department of Pharmaceutics (Clinical Pharmacy), Faculty of Pharmacy, Slipakorn University, Nakornprathom 73000, Thailand;
| | - Pittaya Piroonamornpun
- Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand; (P.P.); (T.P.); (C.D.)
| | - Thitiya Ponam
- Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand; (P.P.); (T.P.); (C.D.)
| | - Chatnapa Duangdee
- Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand; (P.P.); (T.P.); (C.D.)
| | - Phanita Chankete
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand; (M.V.); (P.C.)
| | - Anupop Jitmuang
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (A.J.); (V.T.)
| | - Visanu Thamlikitkul
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (A.J.); (V.T.)
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16
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Soldevila L, Prat N, Mas MÀ, Massot M, Miralles R, Bonet-Simó JM, Isnard M, Expósito-Izquierdo M, Garcia-Sanchez I, Rodoreda-Noguerola S, Moreno N, Badia E, López G, Sevilla J, Estrada O, Vallès X. The interplay between infection risk factors of SARS-CoV-2 and mortality: a cross-sectional study from a cohort of long-term care nursing home residents. BMC Geriatr 2022; 22:123. [PMID: 35164680 PMCID: PMC8842505 DOI: 10.1186/s12877-022-02779-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 01/13/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Covid-19 pandemic has particularly affected older people living in Long-term Care settings in terms of infection and mortality. METHODS We carried out a cross-sectional analysis within a cohort of Long-term care nursing home residents between March first and June thirty, 2020, who were ≥ 65 years old and on whom at least one PCR test was performed. Socio-demographic, comorbidities, and clinical data were recorded. Facility size and community incidence of SARS-CoV-2 were also considered. The outcomes of interest were infection (PCR positive) and death. RESULTS A total of 8021 residents were included from 168 facilities. Mean age was 86.4 years (SD = 7.4). Women represented 74.1%. SARS-CoV-2 infection was detected in 27.7% of participants, and the overall case fatality rate was 11.3% (24.9% among those with a positive PCR test). Epidemiological factors related to risk of infection were larger facility size (pooled aOR 1.73; P < .001), higher community incidence (pooled aOR 1.67, P = .04), leading to a higher risk than the clinical factor of low level of functional dependence (aOR 1.22, P = .03). Epidemiological risk factors associated with mortality were male gender (aOR 1.75; P < .001), age (pooled aOR 1.16; P < .001), and higher community incidence (pooled aOR 1.19, P = < 0.001) whereas clinical factors were low level of functional dependence (aOR 2.42, P < .001), Complex Chronic Condition (aOR 1.29, P < .001) and dementia (aOR 1.33, P <0.001). There was evidence of clustering for facility and health area when considering the risk of infection and mortality (P < .001). CONCLUSIONS Our results suggest a complex interplay between structural and individual factors regarding Covid-19 infection and its impact on mortality in nursing-home residents.
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Affiliation(s)
- Laura Soldevila
- International Health Program, Regió Sanitària Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
- Infectious Diseases Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Fight AIDS and Infectious Diseases Foundation, Badalona, Spain
| | - Núria Prat
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | - Miquel À Mas
- Direcció Clínica Territorial de Cronicitat Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
- Department of Geriatrics, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Mireia Massot
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | - Ramón Miralles
- Direcció Clínica Territorial de Cronicitat Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
- Department of Geriatrics, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Josep M Bonet-Simó
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | - Mar Isnard
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | | | - Irene Garcia-Sanchez
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | - Sara Rodoreda-Noguerola
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | - Nemesio Moreno
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | - Esther Badia
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | - Genís López
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | - Javier Sevilla
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | - Oriol Estrada
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | - Xavier Vallès
- International Health Program, Regió Sanitària Metropolitana Nord, Institut Català de la Salut, Badalona, Spain.
- Fight AIDS and Infectious Diseases Foundation, Badalona, Spain.
- Institut per la Recerca en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain.
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17
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Marin-Gomez FX, Mendioroz-Peña J, Mayer MA, Méndez-Boo L, Mora N, Hermosilla E, Coma E, Vilaseca JM, Leis A, Medina M, Catalina QM, Vidal-Alaball J. Comparing the Clinical Characteristics and Mortality of Residential and Non-Residential Older People with COVID-19: Retrospective Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:483. [PMID: 35010742 PMCID: PMC8744689 DOI: 10.3390/ijerph19010483] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 12/24/2021] [Accepted: 12/30/2021] [Indexed: 01/08/2023]
Abstract
Nursing homes have accounted for a significant part of SARS-CoV-2 mortality, causing great social alarm. Using data collected from electronic medical records of 1,319,839 institutionalised and non-institutionalised persons ≥ 65 years, the present study investigated the epidemiology and differential characteristics between these two population groups. Our results showed that the form of presentation of the epidemic outbreak, as well as some risk factors, are different among the elderly institutionalised population with respect to those who are not. In addition to a twenty-fold increase in the rate of adjusted mortality among institutionalised individuals, the peak incidence was delayed by approximately three weeks. Having dementia was shown to be a risk factor for death, and, unlike the non-institutionalised group, neither obesity nor age were shown to be significantly associated with the risk of death among the institutionalised. These differential characteristics should be able to guide the actions to be taken by the health administration in the event of a similar infectious situation among institutionalised elderly people.
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Affiliation(s)
- Francesc X. Marin-Gomez
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, 08772 St. Fruitós de Bages, Spain; (F.X.M.-G.); (J.M.-P.); (J.V.-A.)
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08772 St. Fruitós de Bages, Spain;
- Faculty of Medicine, University of Vic-Central University of Catalonia (UVIC-UCC), 08500 Vic, Spain;
| | - Jacobo Mendioroz-Peña
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, 08772 St. Fruitós de Bages, Spain; (F.X.M.-G.); (J.M.-P.); (J.V.-A.)
- COVID-19 Response Unit, Department of Health, Generalitat de Catalunya, 08005 Barcelona, Spain
| | - Miguel-Angel Mayer
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra, 08003 Barcelona, Spain;
| | - Leonardo Méndez-Boo
- Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut (ICS), 08007 Barcelona, Spain; (L.M.-B.); (N.M.); (E.H.); (E.C.); (M.M.)
| | - Núria Mora
- Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut (ICS), 08007 Barcelona, Spain; (L.M.-B.); (N.M.); (E.H.); (E.C.); (M.M.)
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
| | - Eduardo Hermosilla
- Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut (ICS), 08007 Barcelona, Spain; (L.M.-B.); (N.M.); (E.H.); (E.C.); (M.M.)
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
| | - Ermengol Coma
- Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut (ICS), 08007 Barcelona, Spain; (L.M.-B.); (N.M.); (E.H.); (E.C.); (M.M.)
| | - Josep-Maria Vilaseca
- Faculty of Medicine, University of Vic-Central University of Catalonia (UVIC-UCC), 08500 Vic, Spain;
| | - Angela Leis
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra, 08003 Barcelona, Spain;
| | - Manolo Medina
- Sistemes d’Informació dels Serveis d’Atenció Primària (SISAP), Institut Català de la Salut (ICS), 08007 Barcelona, Spain; (L.M.-B.); (N.M.); (E.H.); (E.C.); (M.M.)
| | - Queralt Miró Catalina
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08772 St. Fruitós de Bages, Spain;
| | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, 08772 St. Fruitós de Bages, Spain; (F.X.M.-G.); (J.M.-P.); (J.V.-A.)
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08772 St. Fruitós de Bages, Spain;
- Faculty of Medicine, University of Vic-Central University of Catalonia (UVIC-UCC), 08500 Vic, Spain;
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18
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Mas MÀ, Mesquida MM, Miralles R, Soldevila L, Prat N, Bonet-Simó JM, Isnard M, Expósito-Izquierdo M, Garcia-Sanchez I, Rodoreda-Noguerola S, Moreno N, Badia E, López G, Sevilla J, Estrada O, Vallès X. Clinical Factors Related to COVID-19 Outcomes in Institutionalized Older Adults: Cross-sectional Analysis from a Cohort in Catalonia. J Am Med Dir Assoc 2021; 22:1857-1859. [PMID: 34375654 PMCID: PMC8289628 DOI: 10.1016/j.jamda.2021.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 07/13/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Miquel Àngel Mas
- Direcció Clínica Territorial de Cronicitat Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain; Department of Geriatrics, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Mireia Massot Mesquida
- Direcció d'Atenció Primaria Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
| | - Ramón Miralles
- Direcció Clínica Territorial de Cronicitat Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain; Department of Geriatrics, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Laura Soldevila
- Infectious Diseases Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; International Health Program, Regió Sanitària Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
| | - Núria Prat
- Direcció d'Atenció Primaria Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
| | - Josep M Bonet-Simó
- Direcció d'Atenció Primaria Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
| | - Mar Isnard
- Direcció d'Atenció Primaria Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
| | | | - Irene Garcia-Sanchez
- Direcció d'Atenció Primaria Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
| | - Sara Rodoreda-Noguerola
- Direcció d'Atenció Primaria Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
| | - Nemesio Moreno
- Direcció d'Atenció Primaria Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
| | - Esther Badia
- Direcció d'Atenció Primaria Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
| | - Genís López
- Direcció d'Atenció Primaria Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
| | - Javier Sevilla
- Direcció d'Atenció Primaria Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
| | - Oriol Estrada
- Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Catalonia, Spain
| | - Xavier Vallès
- International Health Program, Regió Sanitària Metropolitana Nord, Institut Català de la Salut, Badalona, Spain; Institut per la Recerca en Ciències en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
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19
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Soldevila L, Valerio-Sallent L, Roure S, Pérez-Quílez O, Mas MÀ, Miralles R, López-Muñoz I, Estrada O, Vallès X. Drug exposure may have a substantial influence on COVID-19 prognosis among residents of long-term care facilities: an exploratory analysis. Int J Infect Dis 2021; 109:192-194. [PMID: 34242767 PMCID: PMC8260494 DOI: 10.1016/j.ijid.2021.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/01/2021] [Accepted: 07/03/2021] [Indexed: 12/12/2022] Open
Abstract
Objectives To explore the association between drug exposure and SARS-CoV-2 prognosis among elderly people living in long-term care facilities (LTC) Design We carried out a cross-sectional study among old people living in LTC that had a proven SARS-CoV-2 infection, including socio-demographic data, comorbidities and drug intake at the moment of the diagnosis. The study was focused on ACE2 inhibitors, ARA-II blockers, inhaled bronchodilators, oral corticoids, platelet antiaggregants, oral anti-coagulants, statins and Vitamin D. Results 1 306 individuals were included, with a mean age of 86.7 years, and 72.3% were females. The case fatality rate was 24.4%. Among the studied exposures platelet antiaggregants were the most prevalent (24.7%). After adjusting for propensity score, the intake of inhaled corticoids (OR 0.73; p=0.03) and statins (OR 0.65; p=0.03) were found to be protective factors of death, whereas ACE2 inhibitor showed an almost significant association (OR 0.73, p=0.07). Conclusions Considering the high prevalence of drug intake among elderly people, drug exposure may be an important Covid-19 disease modifier in LTC residents and should be considered when exploring prognostic risk factors associated to Covid-19.
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Affiliation(s)
- Laura Soldevila
- Infectious Diseases Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; International Health Program, Regió Sanitària Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
| | - Lluís Valerio-Sallent
- International Health Program, Regió Sanitària Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
| | - Sílvia Roure
- Infectious Diseases Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; International Health Program, Regió Sanitària Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
| | - Olga Pérez-Quílez
- International Health Program, Regió Sanitària Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
| | - Miquel Àngel Mas
- Direcció Clínica Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain; Geriatrics Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Ramón Miralles
- Direcció Clínica Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain; Geriatrics Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Israel López-Muñoz
- International Health Program, Regió Sanitària Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
| | - Oriol Estrada
- Gerència Territorial, Regió Sanitària Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
| | - Xavier Vallès
- International Health Program, Regió Sanitària Metropolitana Nord, Institut Català de la Salut, Badalona, Spain; Institut per la Recerca en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain.
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20
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Ibrahim JE. An equation to predict deaths of nursing home residents during a pandemic. NATURE AGING 2021; 1:571-573. [PMID: 37117805 DOI: 10.1038/s43587-021-00083-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- Joseph E Ibrahim
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, Victorian Institute Forensic Medicine, Southbank, Victoria, Australia.
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