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. 2022 Nov;70(11):3210-3220.
doi: 10.1111/jgs.17975. Epub 2022 Jul 30.

Institutional, therapeutic, and individual factors associated with 30-day mortality after COVID-19 diagnosis in Canadian long-term care facilities

Xi Sophie Zhang  1   2 , Katia Charland  3 , Caroline Quach  4   5 , Quoc Dinh Nguyen  6   7 , Kate Zinszer  3   8
Affiliations

Institutional, therapeutic, and individual factors associated with 30-day mortality after COVID-19 diagnosis in Canadian long-term care facilities

Xi Sophie Zhang et al. J Am Geriatr Soc. 2022 Nov.

Abstract

Background: Canadian long-term care facility (LTCF) residents experienced higher death rates compared to other countries during the first wave of the COVID-19 pandemic. This cohort study analyzes the individual, therapeutic, and institutional factors associated with death in LTCFs.

Methods: Institutional data for 17 LTCFs in Montreal, Canada were obtained from local administrative registries. Individual data for 1197 residents infected by SARS-CoV-2 between February 23 and July 11, 2020 were obtained through chart reviews. A multivariable modified Poisson regression model, which accounted for LTCF clustering, was used to identify resident and facility covariates associated with 30-day mortality after COVID-19 diagnosis.

Results: Severe shortage of licensed practical nurses (RR 2.60 95% CI 1.20-5.61) and medium-sized facilities compared to smaller-sized facilities (RR 2.73 95% CI 1.23-6.07) were associated with 30-day mortality. Later COVID-19 diagnosis (RR 0.98 95% CI 0.97-0.99 per additional day) was associated with survival. Individual risk factors for death included age (RR 1.33 95% CI 1.23-1.45 per additional 10 years), male sex (RR 1.46 95% CI 1.24-1.71), functional impairment (RR 1.08 95% CI 1.04-1.12 per unit increase of SMAF), as well as a diagnosis of congestive heart failure (RR 1.31 95% CI 1.04-1.66) and neurocognitive disorder (RR 1.31 95% CI 1.01-1.70). Among severe cases, anticoagulation was associated with survival (RR 0.70 95% CI 0.51-0.96).

Conclusions: This study identified practical nurse shortages and facility size as institutional risk factors for COVID-19 death. Anticoagulation was associated with survival among severe cases.

Keywords: COVID-19; death; long-term care.

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Conflict of interest statement

The authors have no conflicts and have completed the ICMJE uniform disclosure form at http://www.icmje.org/disclosure-of-interest/.

Figures

FIGURE 1
FIGURE 1
Factors associated with 30‐day mortality after COVID‐19 diagnosis
See this image and copyright information in PMC

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