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. 2021 Jan 15:752:141946.
doi: 10.1016/j.scitotenv.2020.141946. Epub 2020 Aug 25.

Mapping community-level determinants of COVID-19 transmission in nursing homes: A multi-scale approach

Margaret M Sugg  1 , Trent J Spaulding  2 , Sandi J Lane  2 , Jennifer D Runkle  3 , Stella R Harden  4 , Adam Hege  5 , Lakshmi S Iyer  6
Affiliations

Mapping community-level determinants of COVID-19 transmission in nursing homes: A multi-scale approach

Margaret M Sugg et al. Sci Total Environ. .

Abstract

Deaths from the COVID-19 pandemic have disproportionately affected older adults and residents in nursing homes. Although emerging research has identified place-based risk factors for the general population, little research has been conducted for nursing home populations. This GIS-based spatial modeling study aimed to determine the association between nursing home-level metrics and county-level, place-based variables with COVID-19 confirmed cases in nursing homes across the United States. A cross-sectional research design linked data from Centers for Medicare & Medicaid Services, American Community Survey, the 2010 Census, and COVID-19 cases among the general population and nursing homes. Spatial cluster analysis identified specific regions with statistically higher COVID-19 cases and deaths among residents. Multivariate analysis identified risk factors at the nursing home level including, total count of fines, total staffing levels, and LPN staffing levels. County-level or place-based factors like per-capita income, average household size, population density, and minority composition were significant predictors of COVID-19 cases in the nursing home. These results provide a framework for examining further COVID-19 cases in nursing homes and highlight the need to include other community-level variables when considering risk of COVID-19 transmission and outbreaks in nursing homes.

Keywords: COVID-19; Multilevel models; Nursing homes; Spatial analysis.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Unlabelled Image
Graphical abstract
Fig. 1
Fig. 1
Geographic distribution of Confirmed COVID-19 Cases (upper, far left), Nursing Home Resident COVID-19 cases (upper, far right), Staff Covid-19 Cases (lower, far left), Nursing Home Resident COVID-19 Deaths (lower, far right).
Fig. 2
Fig. 2
Hot Spot Analysis (Spatial Clustering) of Nursing Home COVID-19 cases (top) and general population COVID-19 cases (bottom).
Fig. 3
Fig. 3
Centers for Medicare and Medicaid (CMS) Regions used for stratified analysis by geography.
Supplemental Fig. 1
Supplemental Fig. 1
Correlation matrix between nursing home metrics.
Supplemental Fig. 2
Supplemental Fig. 2
Correlation matrix between county-level variables.
See this image and copyright information in PMC

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