National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain.
Consortium for Biomedical Research in Neurodegenerative Diseases (Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas-CIBERNED), Madrid, Spain.
PLoS One. 2019 Mar 1;14(3):e0197789. doi: 10.1371/journal.pone.0197789. eCollection 2019.
Nursing or care home characteristics may have a long-term impact on the residents' mortality risks that has not been studied previously. The study's main objective was to assess the association between facility ownership and long-term, all-cause mortality.
We conducted a mortality follow-up study on a cohort of 611 nursing-home residents in the city Madrid, Spain, from their 1998-1999 baseline interviews up to September 2013. Residents lived in three types of facilities: public, subsidized and private, which were also sub-classified according to size (number of beds). Residents' information was collected by interviewing the residents themselves, their caregivers and facility physicians. We used time-to-event multivariable models and inverse probability weighting to estimate standardized mortality risk differences.
After a 3728 person-year follow-up (median/maximum of 4.8/15.2 years), 519 participants had died. In fully-adjusted models, the standardized mortality risk difference at 5 years of follow-up between medium-sized private facilities and large-sized public facilities was -18.9% (95% confidence interval [CI]: -33.4 to -4.5%), with a median survival (95% CI) of 3.6 (0.5 to 6.8) additional years. The fully-standardized 5-year mortality difference (95% CIs) between for-profit private facilities and not-for-profit public institutions was -15.1% (-31.1% to 0.9%), and the fully-standardized median survival difference (95% CIs) was 3.0 (-1.7 to 7.7) years.
These results are compatible with an association between factors related with the ownership of facilities and the long-term mortality risk of their residents. One of these factors, the facility size, could partly explain this association.
护理院或养老院的特点可能对居民的死亡率产生长期影响，这一点尚未得到研究。本研究的主要目的是评估机构所有权与长期全因死亡率之间的关系。
我们对西班牙马德里市的一个护理院居民队列进行了一项死亡率随访研究，该队列由 1998-1999 年基线访谈时的 611 名居民组成，随访至 2013 年 9 月。居民居住在三种类型的机构中：公立、补贴和私立，这些机构还根据规模（床位数量）进行了细分。居民的信息通过对居民本人、护理人员和机构医生进行访谈收集。我们使用时间事件多变量模型和逆概率加权来估计标准化死亡率风险差异。
在 3728 人年的随访（中位数/最大随访时间 4.8/15.2 年）后，519 名参与者死亡。在完全调整的模型中，5 年随访时中型私立机构与大型公立机构之间的标准化死亡率风险差异为-18.9%（95%置信区间[CI]：-33.4 至-4.5%），中位生存时间（95%CI）为 3.6（0.5 至 6.8）年。营利性私立机构与非营利性公立机构之间的完全标准化 5 年死亡率差异（95%CI）为-15.1%（-31.1%至 0.9%），完全标准化的中位生存时间差异（95%CI）为 3.0（-1.7 至 7.7）年。
这些结果与机构所有权相关因素与居民长期死亡率之间存在关联的观点一致。其中一个因素，即机构规模，可能部分解释了这种关联。
