Cyrus M. Kosar (
Elizabeth M. White is an investigator in the Center for Gerontology and Healthcare Research, Brown University School of Public Health.
Health Aff (Millwood). 2021 Apr;40(4):655-663. doi: 10.1377/hlthaff.2020.02191. Epub 2021 Mar 11.
Improved therapeutics and supportive care in hospitals have helped reduce mortality from COVID-19. However, there is limited evidence as to whether nursing home residents, who account for a disproportionate share of COVID-19 deaths and are often managed conservatively in the nursing home instead of being admitted to the hospital, have experienced similar mortality reductions. In this study we examined changes in thirty-day mortality rates between March and November 2020 among 12,271 nursing home residents with COVID-19. We found that adjusted mortality rates significantly declined from a high of 20.9 percent in early April to 11.2 percent in early November. Mortality risk declined for residents with both symptomatic and asymptomatic infections and for residents with both high and low clinical complexity. The mechanisms driving these trends are not entirely understood, but they may include improved clinical management within nursing homes, improved personal protective equipment supply and use, and genetic changes in the virus.
医院的治疗方法和支持性护理有所改进，有助于降低 COVID-19 的死亡率。然而，关于占 COVID-19 死亡人数不成比例的养老院居民是否经历了类似的死亡率降低，证据有限，而且他们通常在养老院接受保守治疗而不是住院治疗。在这项研究中，我们调查了 2020 年 3 月至 11 月期间患有 COVID-19 的 12271 名养老院居民的 30 天死亡率变化。我们发现，调整后的死亡率从 4 月初的 20.9%显著下降到 11 月上旬的 11.2%。有症状和无症状感染的居民以及临床复杂程度高和低的居民的死亡风险都有所下降。推动这些趋势的机制尚不完全清楚，但可能包括养老院内临床管理的改善、个人防护设备供应和使用的改善，以及病毒的遗传变化。
