Aguilar-Palacio Isabel, Maldonado Lina, Malo Sara, Castel-Feced Sara, Cebollada Alberto, Aguilar-Latorre Alejandra, Rabanaque M José
Department of Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain.
Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain.
Heliyon. 2024 Jul 18;10(14):e34840. doi: 10.1016/j.heliyon.2024.e34840. eCollection 2024 Jul 30.
The objective of our study is to analyze the health care received by older adults with COVID-19 according to their place of residence (whether or not they live in a long-term care [LTC] facility) and to find out the effect of health care on mortality.
Retrospective cohort study based in Aragón (Spain) from March 2020 to March 2021 in patients aged 65 years or older with a confirmed COVID-19 infection. The population was classified according to their place of residence (living in a LTC or not). A propensity score was used to match individuals by sex and age. The effect of living in a LTC facility on healthcare delivery and mortality was conducted using adjusted multivariate models. Varimp was used to estimate the best predictors of mortality for both groups.
Healthcare services utilization varied depending on whether the patients lived in a LTC facility or not. The time to diagnosis was shorter in institutionalized patients, but the time to hospital admission was longer. Length of hospital stays, risk of ICU admission and 30-day mortality were also different and remained statistically significant in the adjusted models. The variables that were more important in the association between healthcare utilization and mortality were those associated with greater severity of COVID-19.
There were differences in health care for older adults diagnosed with COVID-19 according to their place of residence. There is a need to strengthen collaboration between professionals in LTC centers and health services to provide equitable health care.
我们研究的目的是根据老年新冠肺炎患者的居住地（无论他们是否居住在长期护理机构）分析其接受的医疗保健情况，并了解医疗保健对死亡率的影响。
2020年3月至2021年3月在西班牙阿拉贡进行的一项回顾性队列研究，研究对象为65岁及以上确诊感染新冠肺炎的患者。根据居住地（是否居住在长期护理机构）对人群进行分类。使用倾向评分按性别和年龄对个体进行匹配。使用调整后的多变量模型分析居住在长期护理机构对医疗服务提供和死亡率的影响。使用变量重要性分析（Varimp）来估计两组死亡率的最佳预测因素。
医疗服务的利用情况因患者是否居住在长期护理机构而有所不同。机构化患者的诊断时间较短，但住院时间较长。住院时间、入住重症监护病房的风险和30天死亡率也有所不同，并且在调整后的模型中仍具有统计学意义。在医疗服务利用与死亡率之间的关联中，更重要的变量是那些与新冠肺炎严重程度较高相关的变量。
根据居住地不同，确诊新冠肺炎的老年人接受的医疗保健存在差异。需要加强长期护理中心专业人员与卫生服务部门之间的合作，以提供公平的医疗保健。
