Division of Health Policy and Outcomes Research, Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York.
Infect Control Hosp Epidemiol. 2022 Aug;43(8):1004-1009. doi: 10.1017/ice.2022.46. Epub 2022 Feb 22.
Residents of long-term care facilities face significantly greater risk of contracting or dying from coronavirus disease 2019 (COVID-19). However, little is known about COVID-19 in assisted living communities (ALCs) and the potential determinants of its spread. We examined the association between COVID-19 cases in ALCs and the proportion of Medicare-Medicaid (dual) eligible minority residents, neighborhood area deprivation, and state COVID-19 policy stringency.
We conducted longitudinal analyses employing data on confirmed COVID-19 cases in ALCs in 5 states. We sought to determine the weekly cumulative number of COVID-19 cases in ALCs. Covariates were ALC characteristics, area deprivation index, and state COVID-19 policy stringency. Multivariate 2-part models were used to determine the associations between independent variables and the likelihood of an outbreak and the overall count of cases.
In our study sample, 201 ALCs (7.04%) reported 1 or more COVID-19 cases as of August 17, 2020. A higher percentage of minority residents was associated with an increased likelihood of an ALC reporting at least 1 COVID-19 case (odds ratio [OR], 1.06; P = .032). Conditional on having at least 1 case, ALCs in states with stricter social distancing policies had lower case counts (incidence rate ratio [IRR], 0.98; P < .001). Greater neighborhood deprivation was associated with higher case count (IRR, 1.36; P = .049).
ALCs with higher proportions of dual-eligible minority residents were more likely to have COVID-19 outbreaks within their communities. ALCs located in more socioeconomically deprived neighborhoods, and in states with less stringent state social distancing policies, tended to have more COVID-19 cases.
长期护理机构的居民面临更大的感染或死于 2019 年冠状病毒病（COVID-19）的风险。然而，人们对辅助生活社区（ALC）中的 COVID-19 以及其传播的潜在决定因素知之甚少。我们研究了 ALC 中的 COVID-19 病例与医疗保险-医疗补助（双重）合格少数民族居民的比例、邻里地区贫困程度和州 COVID-19 政策严格程度之间的关系。
我们对 5 个州的 ALC 确诊 COVID-19 病例进行了纵向分析。我们试图确定 ALC 中 COVID-19 病例的每周累计数量。协变量为 ALC 特征、地区贫困指数和州 COVID-19 政策严格程度。使用多变量两部分模型确定独立变量与爆发的可能性以及病例总数之间的关联。
在我们的研究样本中，截至 2020 年 8 月 17 日，有 201 个 ALC（7.04%）报告了 1 例或多例 COVID-19 病例。少数民族居民比例较高与 ALC 报告至少 1 例 COVID-19 病例的可能性增加有关（优势比[OR]，1.06；P=.032）。在有至少 1 例病例的情况下，社会距离政策较严格的州的 ALC 病例数较低（发病率比[IRR]，0.98；P<.001）。邻里贫困程度较高与病例数较高相关（IRR，1.36；P=.049）。
少数民族双重合格居民比例较高的 ALC 更有可能在其社区内爆发 COVID-19。位于社会经济条件较差的社区的 ALC 以及州社会距离政策较宽松的州，COVID-19 病例往往更多。
