Department of Healthcare Administration, School of Public Health, Loma Linda University, Loma Linda, CA, United States.
Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States.
Front Public Health. 2023 Mar 1;11:1098571. doi: 10.3389/fpubh.2023.1098571. eCollection 2023.
The COVID-19 was declared a pandemic by WHO on 03/2020 has claimed millions of lives worldwide. The US leads all countries in COVID-19-related deaths. Individual level (preexisting conditions and demographics) and county-level (availability of resources) factors have been attributed to increased risk of COVID-19-related deaths. This study builds on previous studies to assess the relationship between county-level resources and COVID-19 mortality among 2,438 US counties. We merged 2019 data from AHA, AHRF, and USA FACTS. The dependent variable was the total number of COVID-19-related deaths. Independent variables included county-level resources: (1) hospital staffing levels (FTE RNs, hospitalists, and intensivists) per 10,000 population; (2) hospital capacity (occupancy rate, proportion of teaching hospitals, and number of airborne infection control rooms per 10,000 population); and (3) macroeconomic resources [per capita income and location (urban/rural)]. We controlled for population 65+, racial/ethnic minority, and COVID-19 deaths per 1,000 population. A negative binomial regression was used. Hospital staffing per 10,000 population {FTE RN [IRR = 0.997; CI (0.995-0.999)], FTE hospitalists [IRR = 0.936; CI (0.897-0.978)], and FTE intensivists [IRR = 0.606; CI (0.516-0.712)]} was associated with lower COVID-19-related deaths. Hospital occupancy rate, proportion of teaching hospitals, and total number of airborne infection control rooms per 10,000 population were positively associated with COVID-19-related deaths. Per capita income and being in an urban county were positively associated with COVID-19-related deaths. Finally, the proportion of 65+, racial/ethnic minorities, and the number of cases were positively associated with COVID-19-related deaths. Our findings suggest that focusing on maintaining adequate hospital staffing could improve COVID-19 mortality.
世界卫生组织于 2020 年 3 月宣布 COVID-19 大流行，全球数百万人因此丧生。美国在与 COVID-19 相关的死亡人数方面处于领先地位。个人层面（先前存在的疾病和人口统计学特征）和县级层面（资源可用性）的因素被归因于 COVID-19 相关死亡风险的增加。本研究在前人的研究基础上，评估了 2438 个美国县的县级资源与 COVID-19 死亡率之间的关系。我们合并了 AHA、AHRF 和 USA FACTS 的 2019 年数据。因变量是与 COVID-19 相关的死亡总数。自变量包括县级资源：（1）每 10000 人拥有的医院工作人员数量（FTE 注册护士、医院医师和重症监护医师）；（2）医院容量（入住率、教学医院比例和每 10000 人拥有的空气传播感染控制室数量）；和（3）宏观经济资源[人均收入和位置（城市/农村）]。我们控制了 65 岁以上人口、少数民族和每 1000 人 COVID-19 死亡人数。使用负二项式回归。每 10000 人拥有的医院工作人员数量（FTE 注册护士[IRR=0.997；CI（0.995-0.999）]、FTE 医院医师[IRR=0.936；CI（0.897-0.978）]和 FTE 重症监护医师[IRR=0.606；CI（0.516-0.712）]）与 COVID-19 相关的死亡人数较低有关。医院入住率、教学医院比例和每 10000 人拥有的空气传播感染控制室总数与 COVID-19 相关的死亡人数呈正相关。人均收入和位于城市县与 COVID-19 相关的死亡人数呈正相关。最后，65 岁以上人口比例、少数民族比例和病例数与 COVID-19 相关的死亡人数呈正相关。我们的研究结果表明，注重维持足够的医院工作人员配备可以提高 COVID-19 的死亡率。
