Department of Geography, Environment, and Spatial Sciences, Michigan State University, East Lansing, Michigan, United States of America.
Newborn Screening Section, Minnesota Department of Health, Minneapolis, Minnesota, United States of America.
PLoS One. 2024 Aug 15;19(8):e0308339. doi: 10.1371/journal.pone.0308339. eCollection 2024.
COVID-19 deaths in nursing homes accounted for 30.2% of all COVID-19 deaths in the United States during the early weeks (1-January to 26-July, 2020) of the pandemic. This study presents the geographic diffusion of COVID-19 cases and deaths in nursing homes during this time period, while also providing explanation of regional risk factors.
Nursing home COVID-19 data on confirmed cases (n = 173,452) and deaths (n = 46,173) were obtained from the Centers for Medicare and Medicaid Services. Weekly COVID-19 case counts were spatially smoothed to identify nursing homes in areas of high COVID-19 infection. Bivariate spatial autocorrelation was used to visualize High vs. Low-case counts and related deaths. Zero-inflated negative binomial models were estimated within Health and Human Service (HHS) Regions at three-week intervals to evaluate facility and area-level risk factors. The first reported nursing home resident to die of COVID-19 was in the state of Washington on 28-February, 2020. By 24-May, 2020 there were simultaneous epicenters in the Northeast (HHS Regions 1 and 2) and Midwest (HHS Region 5) with diffusion into the South (HHS Regions 4 and 6) from 15-June to 5-July, 2020. The case-fatality rate was highest from 25-May to 14-June, 2020 (30.9 deaths per 1000 residents); thereafter declining to 24.1 (15-June to 5-July, 2020) and 19.4 (6-July to 26-July, 2020) (overall case-fatality rate 1-January to 26-July = 26.6). Statistically significant risk factors for COVID-19 deaths were admission of patients with COVID-19 into nursing homes, staff confirmed infections and nursing shortages. COVID-19 deaths were likely to occur in nursing homes in high minority and non-English speaking neighborhoods and neighborhoods with a high proportion of households with disabilities.
Enhanced communication between HHS regional administrators about "lessons learned" could provide receiving state health departments with timely information to inform clinical practice to prevent premature death in nursing homes in future pandemics.
在新冠疫情早期（2020 年 1 月 1 日至 7 月 26 日），美国养老院的新冠死亡人数占全美新冠死亡总人数的 30.2%。本研究呈现了这一时期养老院新冠病例和死亡的地理扩散情况，并对区域风险因素进行了说明。
从联邦医疗保险和医疗补助服务中心（Centers for Medicare and Medicaid Services）获取养老院的新冠确诊病例（n=173452）和死亡病例（n=46173）数据。对每周的新冠病例数进行空间平滑处理，以识别感染高风险的养老院。采用双变量空间自相关来可视化高病例区和低病例区及相关死亡情况。每隔三周在卫生与公众服务部（HHS）区域内使用零膨胀负二项模型来评估设施和区域层面的风险因素。首例报告的死于新冠的养老院居民出现在 2020 年 2 月 28 日的华盛顿州。到 2020 年 5 月 24 日，东北部（HHS 区域 1 和 2）和中西部（HHS 区域 5）同时出现疫情中心，并于 2020 年 6 月 15 日至 7 月 5 日向南部（HHS 区域 4 和 6）扩散。发病率最高的时期是 2020 年 5 月 25 日至 6 月 14 日（每 1000 名居民中有 30.9 人死亡）；此后下降到 2020 年 6 月 15 日至 7 月 5 日的 24.1 人死亡和 7 月 6 日至 7 月 26 日的 19.4 人死亡（2020 年 1 月 1 日至 7 月 26 日的总病死率为 26.6%）。新冠死亡的统计学显著风险因素包括确诊新冠患者入院、员工感染和护理人员短缺。新冠死亡很可能发生在少数民族和非英语社区以及残疾人口比例较高的社区的养老院中。
增强 HHS 区域管理员之间的沟通，分享“经验教训”，可以使接收州卫生部门及时获得信息，以便在未来的大流行中为养老院的临床实践提供信息，预防过早死亡。
