社区老年人护理院中 COVID-19 爆发的危险因素的横断面分析。

Cross-Sectional Analysis of Risk Factors for Outbreak of COVID-19 in Nursing Homes for Older Adults in the Community of Madrid.

机构信息

Department of Medical Specialties and Public Health, Rey Juan Carlos University, Madrid, Spain.

Clinical Microbiology and Infectious Diseases, IdISSC and IML Health Institutes, Hospital Universitario San Carlos, Madrid, Spain.

出版信息

Gerontology. 2023;69(2):163-171. doi: 10.1159/000524553. Epub 2022 Jun 2.

DOI:10.1159/000524553

PMID:35654010

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9393782/

Abstract

INTRODUCTION

Nursing homes for older adults have been hot spots for SARS-CoV-2 infections and mortality. Factors that facilitate COVID-19 outbreaks in these settings need to be assessed.

METHODS

A retrospective cross-sectional study of a cohort of residents and workers in nursing homes taking occasion of a point seroprevalence survey was done in the Community of Madrid. Factors related to outbreaks in these facilities were analyzed.

RESULTS

A total of 369 nursing homes for older adults, making a population of 23,756 residents and 20,795 staff members, were followed from July to December 2020. There were 54.2% SARS-CoV-2 IgG+ results in residents and in 32.2% of workers. Sixty-two nursing homes (16.8%) had an outbreak during the follow-up. Nursing homes with outbreaks had more residents than those without (median number of 81 [IQR, 74] vs. 50 [IQR, 56], p < 0.001). Seropositivity for SARS-CoV-2 was lower in facilities with versus without outbreaks, for residents (42.2% [IQR, 55.7] vs. 58.7% [IQR, 43.4], p = 0.002) and for workers (23.9% [IQR, 26.4] vs. 32.8% [IQR, 26.3], p = 0.01). For both residents and staff, the number of infections in outbreaks was larger in centers with lower, as compared with intermediate or high seroprevalence. The size of the facility did not correlate with the number of cases in the outbreak. Taking the incidence of cases in the community as a time-dependent variable (p = 0.03), a Cox analysis (HR [95% CI], p) showed that intermediate or high seroprevalence among residents in the facility was related to a reduction of 55% (0.45 [0.25-0.80], p = 0.007) and 78% (0.22 [0.10-0.48], p < 0.001) in the risk of outbreaks, respectively, as compared with low sero-prevalence. Also, as compared with smaller, medium (1.91 [1.00-3.65], p = 0.05) or large centers (4.57 [2.38-8.75], p < 0.001) had more respective risk of outbreaks.

CONCLUSIONS

The size of the facility and the seroprevalence among residents in nursing homes, and the incidence of infections in the community, are associated with the risk of outbreaks of COVID-19. Facilities with greater proportion of seropositives had smaller number of cases. Monitoring of immunity in nursing homes may help detect those at a greater risk of future cases.

摘要

引言

老年人疗养院一直是 SARS-CoV-2 感染和死亡的热点。需要评估促进这些环境中 COVID-19 爆发的因素。

方法

在马德里社区进行的一次点血清流行率调查中，对护理院居民和工作人员的队列进行了回顾性横断面研究。分析了这些设施中暴发的相关因素。

结果

2020 年 7 月至 12 月，共监测了 369 家老年人疗养院，居民 23756 人，工作人员 20795 人。居民 SARS-CoV-2 IgG+ 结果为 54.2%，工作人员为 32.2%。在随访期间，有 62 家疗养院（16.8%）发生了暴发。暴发的疗养院的居民人数多于未暴发的疗养院（中位数分别为 81 [IQR，74]和 50 [IQR，56]，p<0.001）。与未暴发的疗养院相比，暴发疗养院的居民（42.2% [IQR，55.7] vs. 58.7% [IQR，43.4]，p=0.002）和工作人员（23.9% [IQR，26.4] vs. 32.8% [IQR，26.3]，p=0.01）的 SARS-CoV-2 血清阳性率较低。对于居民和工作人员来说，与中间或高血清流行率相比，低血清流行率的中心的暴发中感染的数量更大。设施规模与暴发中的病例数不相关。以社区病例的发病率为时间依赖性变量（p=0.03），Cox 分析（HR [95%CI]，p）显示，设施中居民的中间或高血清流行率分别与暴发风险降低 55%（0.45 [0.25-0.80]，p=0.007）和 78%（0.22 [0.10-0.48]，p<0.001）相关，与低血清流行率相比。此外，与较小的疗养院（1.91 [1.00-3.65]，p=0.05）或大型疗养院（4.57 [2.38-8.75]，p<0.001）相比，中等规模（1.91 [1.00-3.65]，p=0.05）或大型疗养院（4.57 [2.38-8.75]，p<0.001）发生暴发的风险更高。