Paranthaman Karthik, Allen Hester, Chudasama Dimple, Verlander Neville Q, Sedgwick James
Field Service, UK Health Security Agency, London, UK
COVID-19 Epidemiology Cell, UK Health Security Agency, London, UK.
J Epidemiol Community Health. 2021 Nov 11. doi: 10.1136/jech-2021-218135.
Persons living in long-term care facilities (LTCFs) are presumed to be at higher risk of adverse outcomes from SARS-CoV-2 infection due to increasing age and frailty, but the magnitude of increased risk is not well quantified.
After linking demographic and mortality data for cases with confirmed SARS-CoV-2 infection between March 2020 and January 2021 in England, a random sample of 6000 persons who died and 36 000 who did not die within 28 days of a positive test was obtained from the dataset of 3 020 800 patients. Based on an address-matching process, the residence type of each case was categorised into one of private home and residential or nursing LTCF. Univariable and multivariable logistic regression analysis was conducted.
Multivariable analysis showed that an interaction effect between age and residence type determined the outcome. Compared with a 60-year-old person not living in LTCF, the adjusted OR (aOR) for same-aged persons living in residential and nursing LTCFs was 1.77 (95% CI 1.21 to 2.6, p=0.0017) and 3.95 (95% CI 2.77 to 5.64, p<0.0001), respectively. At 90 years of age, aORs were 0.87 (95% CI 0.72 to 1.06, p=0.21) and 0.74 (95% CI 0.61 to 0.9, p=0.001), respectively. The model had an overall accuracy of 94.2% (94.2%) when applied to the full dataset of 2 978 800 patients.
This study found that residents of LTCFs in England had higher odds of death up to 80 years of age. Beyond 80 years, there was no difference in the odds of death for LTCF residents compared with those in the wider community.
由于年龄增长和身体虚弱，长期护理机构（LTCF）中的居民被认为感染新型冠状病毒（SARS-CoV-2）后出现不良后果的风险更高，但风险增加的程度尚未得到很好的量化。
在将2020年3月至2021年1月英格兰确诊感染SARS-CoV-2的病例的人口统计学和死亡率数据进行关联后，从3020800名患者的数据集中抽取了6000名在检测呈阳性后28天内死亡的人和36000名未死亡的人作为随机样本。基于地址匹配过程，将每个病例的居住类型分为私人住宅和住宿或护理型长期护理机构中的一种。进行了单变量和多变量逻辑回归分析。
多变量分析表明，年龄和居住类型之间的交互作用决定了结果。与未居住在长期护理机构中的60岁老人相比，居住在住宿和护理型长期护理机构中的同龄人的调整后比值比（aOR）分别为1.77（95%置信区间1.21至2.6，p = 0.0017）和3.95（95%置信区间2.77至5.64，p < 0.0001）。在90岁时，aOR分别为0.87（95%置信区间0.72至1.06，p = 0.21）和0.74（95%置信区间0.61至0.9，p = 0.001）。当应用于2978800名患者的完整数据集时，该模型的总体准确率为94.2%（94.2%）。
本研究发现，英格兰长期护理机构的居民在80岁之前死亡几率更高。80岁之后，长期护理机构居民的死亡几率与更广泛社区的居民相比没有差异。
