A retrospective cohort study of risk factors for mortality among nursing homes exposed to COVID-19 in Spain

Suñer, Clara; Ouchi, Dan; Mas, Miquel Àngel; Alarcon, Rosa Lopez; Mesquida, Mireia Massot; Prat, Núria; Bonet-Simó, Josep Maria; Izquierdo, Marta Expósito; Sánchez, Irene; Noguerola, Sara Rodoreda; Colet, M.; Puigvendrelló, Joaquim Verdaguer; Henríquez, N; Miralles, Ramón; Negredo, Eugènia; Noguera-Julián, Marc; Marks, Michael; Estrada, Oriol; Ara, Jordi; Mitjà, Oriol

doi:10.1038/s43587-021-00079-7

Cited by 24 publications

(23 citation statements)

References 25 publications

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“…The fact of presenting some level of complexity according to the grouping or case-mix used seems to be associated with a higher probability of death, and this probability increases as we increase the level of complexity studied. A previous study has already established such an association, revealing a 7% increase in the proportion of COVID-19 deaths among residents with complex conditions [ 41 ]. When we analyse the other demographic factors, we see that the male gender, as noted in previous studies, is also associated with a higher probability of death among COVID-19 cases, whether IOP or not [ 42 ].…”

Section: Discussionmentioning

confidence: 89%

Comparing the Clinical Characteristics and Mortality of Residential and Non-Residential Older People with COVID-19: Retrospective Observational Study

Marín-Gomez

Mendioroz-Peña

Mayer

et al. 2022

IJERPH

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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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Section: Discussionmentioning

confidence: 89%

Comparing the Clinical Characteristics and Mortality of Residential and Non-Residential Older People with COVID-19: Retrospective Observational Study

Marín-Gomez

Mendioroz-Peña

Mayer

et al. 2022

IJERPH

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“…3 Although one fatal case was not SARS-CoV-2 PCR positive, this death was classified as COVID-19-related due to severe respiratory symptoms and recent close contact with positive residents. 4 Considering only the 29 residents of the two affected wards, positivity rates increase up to 69.0%.…”

Section: Discussionmentioning

confidence: 98%

“…3 A meta-analysis of the rst COVID-19 wave in Spain found that mortality at the facility level was signi cantly associated with a higher percentage of patients with complex diseases, lower scores on pandemic preparedness measures and higher population incidence of COVID-19 in the surrounding population. 4 To protect this highly vulnerable population, the roll out of the vaccination campaign was initially targeted towards elderly persons and healthcare workers. Nursing home residents are usually characterized by advanced age, a wide arsenal of co-morbidities and associated polypharmacy, and a decreased function of the immune system, potentially resulting in a higher risk of breakthrough infections.…”

Section: Read Full Licensementioning

confidence: 99%

“…Nursing home residents are usually characterized by advanced age, a wide arsenal of co-morbidities and associated polypharmacy, and a decreased function of the immune system, potentially resulting in a higher risk of breakthrough infections. [4][5][6][7][8] Vaccination in Belgian nursing homes began in the second half of December 2020, employing mainly the mRNA vaccine BNT162b2. The BNT162b2 vaccine is highly effective at protecting against COVID-19 hospitalization and death, with e cacies of 90-95% reported in phase 3 clinical trials, 9 and con rmed in large-scale real life studies.…”

Section: Read Full Licensementioning

confidence: 99%

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Comprehensive immunovirological and environmental screening reveals risk factors for fatal COVID-19 during post-vaccination nursing home outbreaks

Cuypers

Keyaerts

Hong

et al. 2022

Preprint

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COVID-19 vaccination has resulted in excellent protection against fatal disease, including in the elderly. However, risk factors for post-vaccination fatal COVID-19 are largely unknown. We comprehensively studied three large nursing home outbreaks (20-35% fatal cases) by combining SARS-CoV-2 aerosol monitoring, whole-genome phylogenetic analysis, and immunovirological profiling by digital nCounter transcriptomics. Phylogenetic investigations indicated each outbreak stemmed from a single introduction event, though with different variants (Delta, Gamma, and Mu). SARS-CoV-2 was detected in aerosol samples up to 52 days 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 signatures and reanalysis of single-cell RNAseq data highlights the unique 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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“…We selected factors that were clinically meaningful to determine mortality rate and AMR-EC carriage. List of factors [ 8 , 17 , 18 , 19 , 27 , 35 ] were as follows; The age group was classified to be less than 80 years, or equal to and more than 80 years, based on the mean age of our study population; this age was also referred to when determining the mortality risk [ 36 ]. Comorbidities were categorized into single or multiple comorbidities; the duration of living in a nursing home was classified into two: <1 or ≥1 year.…”

Section: Methodsmentioning

confidence: 99%

Mortality in Thai Nursing Homes Based on Antimicrobial-Resistant Enterobacterales Carriage and COVID-19 Lockdown Timing: A Prospective Cohort Study

et al. 2022

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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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A retrospective cohort study of risk factors for mortality among nursing homes exposed to COVID-19 in Spain

Cited by 24 publications

References 25 publications

Comparing the Clinical Characteristics and Mortality of Residential and Non-Residential Older People with COVID-19: Retrospective Observational Study

Comparing the Clinical Characteristics and Mortality of Residential and Non-Residential Older People with COVID-19: Retrospective Observational Study

Comprehensive immunovirological and environmental screening reveals risk factors for fatal COVID-19 during post-vaccination nursing home outbreaks

Mortality in Thai Nursing Homes Based on Antimicrobial-Resistant Enterobacterales Carriage and COVID-19 Lockdown Timing: A Prospective Cohort Study

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