加拿大安大略省养老院中严重急性呼吸综合征冠状病毒2感染暴发的风险因素：一项基于人群的队列研究。
Risk factors for outbreaks of SARS-CoV-2 infection at retirement homes in Ontario, Canada: a population-level cohort study.
作者信息
Costa Andrew P, Manis Derek R, Jones Aaron, Stall Nathan M, Brown Kevin A, Boscart Veronique, Castellino Adriane, Heckman George A, Hillmer Michael P, Ma Chloe, Pham Paul, Rais Saad, Sinha Samir K, Poss Jeffrey W
机构信息
Department of Health Research Methods, Evidence, and Impact (Costa, Manis, Jones, Poss), Department of Medicine (Costa), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont.; Schlegel Research Institute for Aging (Costa, Boscart, Heckman), Waterloo, Waterloo, Ont.; Institute for Clinical Evaluative Sciences (IC/ES) (Costa, Jones, Stall), Toronto, Ont.; Centre for Health Economics and Policy Analyses (Costa, Manis), St. Joseph's Health System, Hamilton, Ont.; Division of General Internal Medicine and Geriatric Medicine (Stall, Sinha), Sinai Health and University Health Network; Department of Medicine (Stall, Sinha), University of Toronto; Institute of Health Policy, Management and Evaluation (Stall, Hillmer, Sinha), University of Toronto; Women's College Research Institute, Women's College Hospital (Stall); National Institute on Ageing, Ryerson University (Stall, Sinha); Infection Prevention and Control (Brown), Public Health Ontario; Dalla Lana School of Public Health (Brown), University of Toronto, Toronto, Ont.; Conestoga College Institute of Technology and Advanced Learning (Boscart), Kitchener, Ont.; Retirement Homes Regulatory Authority (RHRA) (Castellino, Ma, Pham), Toronto, Ont.; School of Public Health and Health Systems (Heckman, Poss), University of Waterloo, Waterloo, Ont.; Capacity Planning and Analytics (Hillmer, Rais), Ontario Ministry of Health, Toronto, Ont.
出版信息
CMAJ. 2021 May 10;193(19):E672-E680. doi: 10.1503/cmaj.202756.
BACKGROUND
The epidemiology of SARS-CoV-2 infection in retirement homes (also known as assisted living facilities) is largely unknown. We examined the association between home-and community-level characteristics and the risk of outbreaks of SARS-CoV-2 infection in retirement homes since the beginning of the first wave of the COVID-19 pandemic.
METHODS
We conducted a population-based, retrospective cohort study of licensed retirement homes in Ontario, Canada, from Mar. 1 to Dec. 18, 2020. Our primary outcome was an outbreak of SARS-CoV-2 infection (≥ 1 resident or staff case confirmed by validated nucleic acid amplification assay). We used time-dependent proportional hazards methods to model the associations between retirement home- and community-level characteristics and outbreaks of SARS-CoV-2 infection.
RESULTS
Our cohort included all 770 licensed retirement homes in Ontario, which housed 56 491 residents. There were 273 (35.5%) retirement homes with 1 or more outbreaks of SARS-CoV-2 infection, involving 1944 (3.5%) residents and 1101 staff (3.0%). Cases of SARS-CoV-2 infection were distributed unevenly across retirement homes, with 2487 (81.7%) resident and staff cases occurring in 77 (10%) homes. The adjusted hazard of an outbreak of SARS-CoV-2 infection in a retirement home was positively associated with homes that had a large resident capacity, were co-located with a long-term care facility, were part of larger chains, offered many services onsite, saw increases in regional incidence of SARS-CoV-2 infection, and were located in a region with a higher community-level ethnic concentration.
INTERPRETATION
Readily identifiable characteristics of retirement homes are independently associated with outbreaks of SARS-CoV-2 infection and can support risk identification and priority for vaccination.
背景
养老院（也称为辅助生活设施）中严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染的流行病学情况很大程度上尚不明确。我们研究了自2019冠状病毒病大流行第一波开始以来，家庭和社区层面特征与养老院SARS-CoV-2感染暴发风险之间的关联。
方法
我们对加拿大安大略省持牌养老院进行了一项基于人群的回顾性队列研究，研究时间为2020年3月1日至12月18日。我们的主要结局是SARS-CoV-2感染暴发（≥1例居民或工作人员病例经有效核酸扩增检测确诊）。我们使用时间依赖性比例风险方法来模拟养老院和社区层面特征与SARS-CoV-2感染暴发之间的关联。
结果
我们的队列包括安大略省所有770家持牌养老院，共容纳56491名居民。有273家（35.5%）养老院发生了1次或更多次SARS-CoV-2感染暴发，涉及1944名（3.5%）居民和1101名工作人员（3.0%）。SARS-CoV-2感染病例在各养老院分布不均，2487例（81.7%）居民和工作人员病例发生在77家（10%）养老院。养老院发生SARS-CoV-2感染暴发的校正风险与居民容量大、与长期护理机构位于同一地点、属于较大连锁机构、现场提供多种服务、所在地区SARS-CoV-2感染发病率上升以及位于社区层面种族集中度较高地区的养老院呈正相关。
解读
养老院易于识别的特征与SARS-CoV-2感染暴发独立相关，可有助于风险识别和疫苗接种优先级确定。
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