Department of Veterans Affairs Medical Center, Providence, RI, USA; School of Public Health, Brown University, Providence, RI, USA.
Department of Veterans Affairs Medical Center, Providence, RI, USA; School of Public Health, Brown University, Providence, RI, USA.
J Am Med Dir Assoc. 2022 Oct;23(10):1743-1749.e6. doi: 10.1016/j.jamda.2022.07.023. Epub 2022 Aug 8.
To evaluate whether assisted living (AL) residents with Alzheimer's disease and related dementias (ADRD) experienced a greater rate of excess all-cause mortality during the first several months of the COVID-19 pandemic compared to residents without ADRD, and to compare excess all-cause mortality rates in memory care vs general AL among residents with ADRD.
Retrospective cohort study.
Two cohorts of AL residents enrolled in Medicare Fee-For-Service who resided in 9-digit ZIP codes corresponding to US AL communities of ≥25 beds during calendar year 2019 or 2020.
By linking Medicare claims and Vital Statistics data, we examined the weekly excess all-cause mortality rate, comparing the rate from March 12, 2020, to December 31, 2020, to the rate from January 1, 2019, to March 11, 2020. We adjusted for demographics, chronic conditions, AL community size, and county fixed effects.
Of the 286,350 residents in 2019 and the 273,601 in 2020 identified in these cohorts, approximately 31% had a diagnosis of ADRD. Among all AL residents, the excess weekly mortality rate in 2020 was 49.1 per 100,000 overall during the pandemic. Compared to residents without ADRD, residents with ADRD experienced 33.4 more excess deaths per 100,000 during the pandemic. Among residents with ADRD, those who resided in memory care communities did not experience a statistically significant different mortality rate than residents who lived in general AL.
AL residents with ADRD were more vulnerable to mortality during COVID-19 than residents without ADRD, a finding similar to those reported in other settings such as nursing homes. Additionally, the study provides important new information that residents with ADRD in memory care communities may not have been at differential risk of COVID-19 mortality when compared to residents with ADRD in general AL, despite prior research suggesting they have more advanced dementia.
评估患有阿尔茨海默病和相关痴呆症（ADRD）的辅助生活（AL）居民在 COVID-19 大流行的最初几个月中是否比没有 ADRD 的居民经历了更高的全因超额死亡率，并比较患有 ADRD 的居民中记忆护理与一般 AL 的全因超额死亡率。
回顾性队列研究。
纳入医疗保险付费服务的两个 AL 居民队列，他们居住在 2019 年或 2020 年日历年内对应的美国 AL 社区的 9 位邮政编码≥25 张床位。
通过链接医疗保险索赔和人口统计数据，我们检查了每周全因超额死亡率，将 2020 年 3 月 12 日至 12 月 31 日的死亡率与 2019 年 1 月 1 日至 3 月 11 日的死亡率进行比较。我们调整了人口统计学、慢性疾病、AL 社区规模和县固定效应。
在这两个队列中，2019 年有 286350 名居民，2020 年有 273601 名居民，其中约 31%患有 ADRD 诊断。在所有 AL 居民中，大流行期间 2020 年每周的超额死亡率总体为每 10 万人 49.1 人。与没有 ADRD 的居民相比，患有 ADRD 的居民在大流行期间每 10 万人多 33.4 人超额死亡。在患有 ADRD 的居民中，居住在记忆护理社区的居民与居住在普通 AL 的居民的死亡率没有统计学上的显著差异。
患有 ADRD 的 AL 居民在 COVID-19 期间比没有 ADRD 的居民更容易死亡，这一发现与其他环境（如养老院）报告的结果相似。此外，该研究提供了重要的新信息，表明与一般 AL 中的 ADRD 居民相比，记忆护理社区中的 ADRD 居民在 COVID-19 死亡率方面可能没有差异风险，尽管先前的研究表明他们患有更严重的痴呆症。
