Center of Innovation, Long-Term Services and Support, Providence Veterans Administration Medical Center, Providence, Rhode Island, USA.
Division of Geriatrics and Palliative Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
J Am Geriatr Soc. 2022 Oct;70(10):2973-2979. doi: 10.1111/jgs.17945. Epub 2022 Jun 29.
Alzheimer's disease and related dementias (ADRD) impact the diagnosis and infection control of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in nursing homes (NH) by influencing the behavior of residents and their caregivers. Health system data show an association between ADRD and SARS-CoV-2. Whether this association is present in NH populations remains unknown. How increased SARS-CoV-2 risk among residents with ADRD impacts the greater NH population also remains unknown.
This retrospective cohort study used electronic health record data on Veterans residing in 133 Veterans Affairs Community Living Centers (CLC) and 15 spinal cord injury units from March 1, 2020 to December 13, 2020. We measured ADRD using diagnostic codes 12 months before an index SARS-CoV-2 test date for each resident. We used Poisson regression to determine the relative risk of SARS-CoV-2 for the highest quartile of facility ADRD prevalence versus the lowest, stratifying by individual ADRD status, and adjusting for covariates, with and without a random intercept to account for facility clustering.
Across the study period, 15,043 residents resided in CLCs, 1952 (13.0%) had SARS-CoV-2, and 8067 (53.6%) had ADRD. There was an estimated 60% increased risk of SARS-CoV-2 in facilities with highest dementia prevalence versus lowest (relative risk, 1.6 [95% confidence interval 0.95, 2.7]).
CLC residents had a greater likelihood of SARS-CoV-2 infection in facilities with greater ADRD prevalence. Facility characteristics other than ADRD prevalence may account for this association.
阿尔茨海默病和相关痴呆症（ADRD）通过影响居民及其护理人员的行为，影响疗养院（NH）中严重急性呼吸系统综合症冠状病毒 2 （SARS-CoV-2）的诊断和感染控制。卫生系统数据显示 ADRD 与 SARS-CoV-2 之间存在关联。这种关联是否存在于 NH 人群中尚不清楚。ADRD 居民中 SARS-CoV-2 风险增加如何影响更大的 NH 人群也尚不清楚。
本回顾性队列研究使用了 2020 年 3 月 1 日至 2020 年 12 月 13 日期间居住在 133 个退伍军人事务社区生活中心（CLC）和 15 个脊髓损伤病房的退伍军人的电子健康记录数据。我们使用每个居民的 SARS-CoV-2 检测日期前 12 个月的诊断代码来衡量 ADRD。我们使用泊松回归来确定设施 ADRD 患病率最高四分位数与最低四分位数相比的 SARS-CoV-2 相对风险，按个体 ADRD 状况分层，并调整了协变量，包括有无随机截距以考虑设施聚类。
在整个研究期间，有 15043 名居民居住在 CLC 中，有 1952 名（13.0%）居民患有 SARS-CoV-2，有 8067 名（53.6%）居民患有 ADRD。在痴呆症患病率最高的设施中，SARS-CoV-2 的风险估计增加了 60%，而在患病率最低的设施中，SARS-CoV-2 的风险增加了 60%（相对风险，1.6 [95%置信区间 0.95，2.7]）。
在 ADRD 患病率较高的设施中，CLC 居民更有可能感染 SARS-CoV-2。除了 ADRD 患病率之外，设施特征可能是造成这种关联的原因。
