Department of General Medicine, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada.
Department of Family and Emergency Medicine, University of Montreal, Montreal, Canada.
J Am Geriatr Soc. 2022 Nov;70(11):3210-3220. doi: 10.1111/jgs.17975. Epub 2022 Jul 30.
Canadian long-term care facility (LTCF) residents experienced higher death rates compared to other countries during the first wave of the COVID-19 pandemic. This cohort study analyzes the individual, therapeutic, and institutional factors associated with death in LTCFs.
Institutional data for 17 LTCFs in Montreal, Canada were obtained from local administrative registries. Individual data for 1197 residents infected by SARS-CoV-2 between February 23 and July 11, 2020 were obtained through chart reviews. A multivariable modified Poisson regression model, which accounted for LTCF clustering, was used to identify resident and facility covariates associated with 30-day mortality after COVID-19 diagnosis.
Severe shortage of licensed practical nurses (RR 2.60 95% CI 1.20-5.61) and medium-sized facilities compared to smaller-sized facilities (RR 2.73 95% CI 1.23-6.07) were associated with 30-day mortality. Later COVID-19 diagnosis (RR 0.98 95% CI 0.97-0.99 per additional day) was associated with survival. Individual risk factors for death included age (RR 1.33 95% CI 1.23-1.45 per additional 10 years), male sex (RR 1.46 95% CI 1.24-1.71), functional impairment (RR 1.08 95% CI 1.04-1.12 per unit increase of SMAF), as well as a diagnosis of congestive heart failure (RR 1.31 95% CI 1.04-1.66) and neurocognitive disorder (RR 1.31 95% CI 1.01-1.70). Among severe cases, anticoagulation was associated with survival (RR 0.70 95% CI 0.51-0.96).
This study identified practical nurse shortages and facility size as institutional risk factors for COVID-19 death. Anticoagulation was associated with survival among severe cases.
在 COVID-19 大流行的第一波期间，加拿大长期护理机构 (LTCF) 的居民死亡率高于其他国家。本队列研究分析了与 LTCF 死亡相关的个体、治疗和机构因素。
从加拿大蒙特利尔的当地行政登记处获得了 17 家 LTCF 的机构数据。通过图表审查获得了 2020 年 2 月 23 日至 7 月 11 日期间感染 SARS-CoV-2 的 1197 名居民的个人数据。使用多变量修正泊松回归模型，该模型考虑了 LTCF 的聚类，以确定 COVID-19 诊断后 30 天死亡率与居民和设施相关的协变量。
与小型设施相比，执业护士严重短缺 (RR 2.60 95%CI 1.20-5.61) 和中型设施 (RR 2.73 95%CI 1.23-6.07) 与 30 天死亡率相关。COVID-19 诊断较晚 (RR 0.98 95%CI 0.97-0.99 每增加一天) 与存活相关。死亡的个体危险因素包括年龄 (RR 1.33 95%CI 1.23-1.45 每增加 10 岁)、男性 (RR 1.46 95%CI 1.24-1.71)、功能障碍 (RR 1.08 95%CI 1.04-1.12 每增加一个 SMAF 单位)，以及充血性心力衰竭 (RR 1.31 95%CI 1.04-1.66) 和神经认知障碍 (RR 1.31 95%CI 1.01-1.70) 的诊断。在重症病例中，抗凝治疗与生存相关 (RR 0.70 95%CI 0.51-0.96)。
本研究确定了执业护士短缺和设施规模是 COVID-19 死亡的机构危险因素。抗凝治疗与重症病例的生存相关。
