Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
JAMA Netw Open. 2020 Jul 1;3(7):e2015957. doi: 10.1001/jamanetworkopen.2020.15957.
The coronavirus disease 2019 (COVID-19) pandemic has been particularly severe among individuals residing in long-term care (LTC) facilities. As of April 10, 2020, half of Canada's COVID-19 deaths had occurred in LTC facilities.
To better understand trends and risk factors associated with COVID-19 death in LTC facilities in Ontario, Canada.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study of 627 LTC facilities included 269 total individuals who died of COVID-19 in Ontario to April 11, 2020, and 83 individuals who died of COVID-19 in Ontario LTC facilities to April 7, 2020. Because population denominators were not available for LTC residents, they were approximated as the total number of LTC facility beds in Ontario (79 498), assuming complete occupancy.
Confirmed or suspected COVID-19 outbreaks; confirmed COVID-19 infection among residents and staff, diagnosed by real-time polymerase chain reaction testing.
COVID-19-specific mortality incidence rate ratios (IRRs) for LTC residents were calculated with community-living Ontarians older than 69 years as the comparator group. Count-based regression methods were used to model temporal trends and to identify associations of infection risk among staff and residents with subsequent LTC resident death. Model-derived IRRs for COVID-19-specific mortality were generated through bootstrap resampling (1000 replicates) to generate median and 95% credible intervals for IRR over time.
Of 627 LTC facilities, 272 (43.4%) reported COVID-19 infection in residents or staff. Of 1 731 315 total individuals older than 69 years living in Ontario during the study period, 229 (<0.1%) died; of 79 498 potential residents in LTC facilities, 83 (0.1%) died. The IRR for COVID-19-related death in LTC residents was 13.1 (95% CI, 9.9-17.3) compared with community-living adults older than 69 years. The IRR increased sharply over time and was 87.3 (95% credible interval, 6.4-769.8) by April 11, 2020. Infection among LTC staff was associated with death among residents with a 6-day lag (eg, adjusted IRR for death per infected staff member, 1.17; 95% CI, 1.11-1.26).
In this cohort study of COVID-19-related deaths during the pandemic in Ontario, Canada, mortality risk was concentrated in LTC residents and increased during a short period. Early identification of risk requires a focus on testing, providing personal protective equipment to staff, and restructuring the LTC workforce to prevent the movement of COVID-19 between facilities.
2019 年冠状病毒病（COVID-19）大流行在长期护理（LTC）机构的居住者中尤为严重。截至 2020 年 4 月 10 日，加拿大 COVID-19 死亡人数的一半发生在长期护理设施中。
更好地了解与加拿大安大略省长期护理设施中 COVID-19 死亡相关的趋势和危险因素。
设计、设置和参与者：本队列研究包括 627 家长期护理机构，共有 269 名 COVID-19 死亡的个人，其中 83 名 COVID-19 死亡的个人在安大略省长期护理机构，截至 2020 年 4 月 11 日。由于长期护理居民的人口分母不可用，因此他们被近似为安大略省长期护理机构床位总数（79498 张），假设完全入住。
确诊或疑似 COVID-19 爆发；居民和工作人员中确诊的 COVID-19 感染，通过实时聚合酶链反应检测诊断。
将社区居住的 69 岁以上安大略省居民作为比较组，计算长期护理居民的 COVID-19 特异性死亡率发病率比（IRR）。使用基于计数的回归方法对时间趋势进行建模，并确定工作人员和居民的感染风险与随后的长期护理居民死亡之间的关联。通过自举重采样（1000 次重复）生成 COVID-19 特异性死亡率的模型衍生 IRR，以生成 IRR 随时间的中位数和 95%可信区间。
在 627 家长期护理机构中，272 家（43.4%）报告了居民或工作人员的 COVID-19 感染。在研究期间，69 岁以上居住在安大略省的 1731315 名总人数中，有 229 人（<0.1%）死亡；在潜在的 79498 名长期护理机构居民中，有 83 人（0.1%）死亡。长期护理居民的 COVID-19 相关死亡的 IRR 为 13.1（95%CI，9.9-17.3），与社区居住的 69 岁以上成年人相比。IRR 随着时间的推移急剧上升，到 2020 年 4 月 11 日，IRR 达到 87.3（95%可信区间，6.4-769.8）。长期护理工作人员的感染与居民死亡之间存在 6 天的滞后（例如，每感染一名工作人员的死亡调整 IRR，1.17；95%CI，1.11-1.26）。
在加拿大安大略省大流行期间 COVID-19 相关死亡的这项队列研究中，死亡率风险集中在长期护理居民中，并在短时间内增加。早期识别风险需要注重检测、为工作人员提供个人防护设备，并重组长期护理劳动力，以防止设施之间 COVID-19 的传播。
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