美国养老院中 COVID-19 感染和死亡的种族和族裔差异。
Racial and Ethnic Disparities in COVID-19 Infections and Deaths Across U.S. Nursing Homes.
机构信息
Division of Health Policy and Outcomes Research, Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York, USA.
IMPAQ International, LLC, Oakland, California, USA.
出版信息
J Am Geriatr Soc. 2020 Nov;68(11):2454-2461. doi: 10.1111/jgs.16847. Epub 2020 Sep 28.
BACKGROUND/OBJECTIVES: To determine racial/ethnic disparities in weekly counts of new COVID-19 cases and deaths among nursing home residents or staff.
DESIGN
Cross-sectional analysis of national nursing home COVID-19 reports linked to other data. Multivariable two-part models modeled disparities in count of cases or deaths, and logistic regressions modeled disparities in self-reported shortages in staff and personal protective equipment (PPE), across nursing home groups with varying proportions of racial/ethnic minority residents, defined as low-, medium-, medium-high-, and high-proportion groups.
SETTING
A total of 12,576 nursing homes nationally.
PARTICIPANTS
None.
INTERVENTION
None.
MEASUREMENTS
Numbers of incident COVID-19 confirmed cases among residents and staff, and incident COVID-19 related deaths among residents (primary outcomes); and nursing home reported shortages in staff and PPE (secondary outcomes). All outcomes were reported for the week of May 25, 2020.
RESULTS
The number of weekly new COVID-19 confirmed cases among residents ranged from an average of 0.4 cases per facility (standard deviation (SD) = 2.5) for the low-proportion group (93.0% had zero new cases) to 1.5 cases per facility (SD = 6.3) for the high-proportion group (78.9% had zero new cases). Multivariable regression estimated that compared with the low-proportion group, the likelihood of having at least one new resident case was 76% higher (odds ratio = 1.76; 95% confidence interval = 1.38-2.25; P = .000) for the high-proportion group. Similar across-facility disparities were found for the weekly count of new COVID-19 deaths among residents (ranging from 0.1 deaths per facility (SD = 1.1) for the low-proportion group to 0.4 deaths (SD = 2.0) for the high-proportion group) and in the weekly count of new COVID-19 confirmed cases among staff (ranging from 0.3 cases (SD = 1.4] to 1.3 cases (SD = 4.4) per facility). No substantial disparities in self-reported shortages of staff or PPE were found.
CONCLUSION
Nursing homes caring for disproportionately more racial/ethnic minority residents reported more weekly new COVID-19 confirmed cases and/or deaths. Immediate actions are needed to address these system-level disparities.
背景/目的：确定养老院居民或工作人员中新出现的 COVID-19 病例和死亡人数的种族/民族差异。
设计
对与其他数据相关联的全国养老院 COVID-19 报告进行横断面分析。多变量两部分模型对病例或死亡人数的差异进行建模，并对报告的员工和个人防护设备 (PPE) 短缺情况进行逻辑回归建模，这些差异存在于不同少数民族居民比例的养老院群体中，定义为低、中、中高和高比例群体。
地点
全国共有 12576 家养老院。
参与者
无。
干预措施
无。
测量
居民和工作人员中新出现的 COVID-19 确诊病例数，以及居民中与 COVID-19 相关的死亡人数（主要结果）；以及养老院报告的员工和 PPE 短缺情况（次要结果）。所有结果均报告于 2020 年 5 月 25 日当周。
结果
居民每周新出现的 COVID-19 确诊病例数范围从低比例组（93.0% 无新病例）每个设施平均 0.4 例（标准差（SD）=2.5）到高比例组（78.9% 无新病例）每个设施 1.5 例（SD = 6.3）。多变量回归估计，与低比例组相比，高比例组至少有一个新居民病例的可能性高 76%（优势比=1.76；95%置信区间=1.38-2.25；P<.000）。居民每周新出现的 COVID-19 死亡人数的跨设施差异相似（从低比例组的每个设施 0.1 例（SD = 1.1）到高比例组的每个设施 0.4 例（SD = 2.0）），以及工作人员每周新出现的 COVID-19 确诊病例数（从每个设施 0.3 例（SD = 1.4）到 1.3 例（SD = 4.4））。未发现员工或 PPE 短缺的实质性差异。
结论
照顾少数民族居民比例过高的养老院报告了更多的每周新出现的 COVID-19 确诊病例和/或死亡人数。需要立即采取行动解决这些系统层面的差异。
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