Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, The Netherlands.
Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, The Netherlands.
J Am Med Dir Assoc. 2024 Sep;25(9):105116. doi: 10.1016/j.jamda.2024.105116. Epub 2024 Jun 28.
Nursing home residents constituted a vulnerable population during the COVID-19 pandemic, and half of all cause-attributed COVID-19 deaths occurred within nursing homes. Yet, given the low life expectancy of nursing home residents, it is unclear to what extent COVID-19 mortality increased overall mortality within this population. Moreover, there might have been differences between nursing homes in their ability to protect residents against excess mortality. This article estimates the number of excess deaths among Dutch nursing home residents during the pandemic, the variation in excess deaths across nursing homes, and its relationship with nursing home characteristics.
Retrospective, use of administrative register data.
All residents (N = 194,432) of Dutch nursing homes (n = 1463) in 2016-2021.
We estimated the difference between actual and predicted mortality, pooled at the nursing home level, which provided an estimate of nursing home-specific excess mortality corrected for resident case-mix differences. We show the variation in excess mortality across nursing homes and relate this to nursing home characteristics.
In 2020 and 2021, the mortality probability among nursing home residents was 4.0 and 1.6 per 100 residents higher than expected. There was considerable variation in excess deaths across nursing homes, even after correcting for differences in resident case mix and regional factors. This variation was substantially larger than prepandemic mortality and was in 2020 related to prepandemic spending on external personnel and satisfaction with the building, and in 2021 to prepandemic staff absenteeism.
The variation in excess mortality across nursing homes was considerable during the COVID-19 pandemic, and larger compared with prepandemic years. The association of excess mortality with the quality of the building and spending on external personnel indicates the importance of considering differences across nursing home providers when designing policies and guidelines related to pandemic preparedness.
在 COVID-19 大流行期间，养老院居民构成了一个脆弱的群体，所有归因于 COVID-19 的死亡病例中有一半发生在养老院中。然而，考虑到养老院居民的预期寿命较低，尚不清楚 COVID-19 死亡率在该人群的总死亡率中增加了多少。此外，养老院在保护居民免受超额死亡方面的能力可能存在差异。本文旨在估计 COVID-19 大流行期间荷兰养老院居民的超额死亡人数、养老院之间超额死亡人数的差异及其与养老院特征的关系。
回顾性，使用行政登记数据。
2016-2021 年荷兰所有养老院（n=1463 家）的居民（N=194432 人）。
我们估计了实际死亡率与预测死亡率之间的差异，在养老院层面进行了汇总，这提供了一个经过居民病例组合差异校正的特定养老院超额死亡率的估计。我们展示了养老院之间超额死亡人数的差异，并将其与养老院特征联系起来。
2020 年和 2021 年，养老院居民的死亡率比预期高出 4.0 和 1.6 每 100 名居民。即使在考虑了居民病例组合差异和区域因素后，养老院之间的超额死亡人数仍存在很大差异。这种差异明显大于大流行前的死亡率，并且在 2020 年与大流行前对外聘人员的支出和对建筑物的满意度有关，在 2021 年与大流行前的员工缺勤有关。
COVID-19 大流行期间，养老院之间的超额死亡人数差异很大，且与大流行前相比差异更大。超额死亡率与建筑物质量和对外聘人员支出的关系表明，在制定与大流行准备相关的政策和准则时，考虑养老院提供者之间的差异非常重要。
