Department of Family Practice (Cox, McGregor), Faculty of Medicine, University of British Columbia; Centre for Clinical Epidemiology and Evaluation (McGregor), Vancouver Coastal Health Research Institute, Vancouver, BC; School of Public Health Sciences (Poss), University of Waterloo, Waterloo, Ont.; Department of Social and Behavioral Sciences (Harrington), University of California - San Francisco, San Francisco, Calif.
CMAJ Open. 2023 Mar 21;11(2):E267-E273. doi: 10.9778/cmajo.20220022. Print 2023 Mar-Apr.
Long-term care (LTC) in Canada is delivered by a mix of government-, for-profit- and nonprofit-owned facilities that receive public funding to provide care, and were sites of major outbreaks during the early stages of the COVID-19 pandemic. We sought to assess whether facility ownership was associated with COVID-19 outbreaks among LTC facilities in British Columbia, Canada.
We conducted a retrospective observational study in which we linked LTC facility data, collected annually by the Office of the Seniors Advocate BC, with public health data on outbreaks. A facility outbreak was recorded when 1 or more residents tested positive for SARS-CoV-2 between Mar. 1, 2020, and Jan. 31, 2021. We used the Cox proportional hazards method to calculate the adjusted hazard ratio (HR) of the association between risk of COVID-19 outbreak and facility ownership, controlling for community incidence of COVID-19 and other facility characteristics.
Overall, 94 outbreaks involved residents in 80 of 293 facilities. Compared with health authority-owned facilities, for-profit and nonprofit facilities had higher risks of COVID-19 outbreaks (adjusted HR 1.99, 95% confidence interval [CI] 1.12-3.52 and adjusted HR 1.84, 95% CI 1.00-3.36, respectively). The model adjusted for community incidence of infection (adjusted HR 1.12, 95% CI 1.07-1.17), total nursing hours per resident-day (adjusted HR 0.84, 95% CI 0.33-2.14), facility age (adjusted HR 1.01, 95% CI 1.00-1.02), number of facility beds (adjusted HR 1.20, 95% CI 1.12-1.30) and facilities with beds in shared rooms (adjusted HR 1.16, 95% CI 0.73-1.85).
Findings suggest that ownership of LTC facilities by health authorities in BC offered some protection against COVID-19 outbreaks. Further study is needed to unpack the underlying pathways behind this observed association.
加拿大的长期护理（LTC）由政府、营利性和非营利性机构提供，这些机构拥有的设施接受公共资金来提供护理，并且在 COVID-19 大流行的早期是主要爆发的地点。我们试图评估在不列颠哥伦比亚省，加拿大的长期护理设施中，设施所有权是否与 COVID-19 爆发有关。
我们进行了一项回顾性观察研究，将由不列颠哥伦比亚省老年人事务专员办公室每年收集的长期护理设施数据与有关疫情爆发的公共卫生数据联系起来。当 1 名或多名居民在 2020 年 3 月 1 日至 2021 年 1 月 31 日之间检测出 SARS-CoV-2 呈阳性时，即记录为设施爆发。我们使用 Cox 比例风险法计算 COVID-19 爆发风险与设施所有权之间的调整后的危险比（HR），同时控制社区 COVID-19 的发病率和其他设施特征。
总体而言，94 次爆发涉及 293 个设施中的 80 个设施的居民。与卫生当局拥有的设施相比，营利性和非营利性设施发生 COVID-19 爆发的风险更高（调整后的 HR 分别为 1.99，95%置信区间[CI]为 1.12-3.52 和调整后的 HR 1.84，95%CI 为 1.00-3.36）。该模型调整了社区感染发生率（调整后的 HR 1.12，95%CI 1.07-1.17）、每位居民每天的护理总小时数（调整后的 HR 0.84，95%CI 0.33-2.14）、设施年龄（调整后的 HR 1.01，95%CI 1.00-1.02）、设施床位数量（调整后的 HR 1.20，95%CI 1.12-1.30）和设有共享房间床位的设施（调整后的 HR 1.16，95%CI 0.73-1.85）。
研究结果表明，不列颠哥伦比亚省的长期护理设施由卫生当局拥有，这为 COVID-19 爆发提供了一些保护。需要进一步研究来揭示观察到的这种关联背后的潜在途径。
