tetano
Editor, Senior Moderator
Age Ageing
. 2023 Dec 1;52(12):afad229.
doi: 10.1093/ageing/afad229. The association between frailty, long-term care home characteristics and COVID-19 mortality before and after SARS-CoV-2 vaccination: a retrospective cohort study
Darly Dash[SUP] 1 [/SUP], Fabrice I Mowbray[SUP] 2 [/SUP], Jeffrey W Poss[SUP] 3 [/SUP], Komal Aryal[SUP] 1 [/SUP], Nathan M Stall[SUP] 4 5 [/SUP], John P Hirdes[SUP] 3 [/SUP], Michael P Hillmer[SUP] 6 [/SUP], George A Heckman[SUP] 3 [/SUP], Dawn M E Bowdish[SUP] 7 8 [/SUP], Andrew P Costa[SUP] 1 7 [/SUP], Aaron Jones[SUP] 1 [/SUP]
Affiliations
Background: The relative contributions of long-term care (LTC) resident frailty and home-level characteristics on COVID-19 mortality has not been well studied. We examined the association between resident frailty and home-level characteristics with 30-day COVID-19 mortality before and after the availability of SARS-CoV-2 vaccination in LTC.
Methods: We conducted a population-based retrospective cohort study of LTC residents with confirmed SARS-CoV-2 infection in Ontario, Canada. We used multi-level multivariable logistic regression to examine associations between 30-day COVID-19 mortality, the Hubbard Frailty Index (FI), and resident and home-level characteristics. We compared explanatory models before and after vaccine availability.
Results: There were 11,179 and 3,655 COVID-19 cases in the pre- and post-vaccine period, respectively. The 30-day COVID-19 mortality was 25.9 and 20.0% during the same periods. The median odds ratios for 30-day COVID-19 mortality between LTC homes were 1.50 (95% credible interval [CrI]: 1.41-1.65) and 1.62 (95% CrI: 1.46-1.96), respectively. In the pre-vaccine period, 30-day COVID-19 mortality was higher for males and those of greater age. For every 0.1 increase in the Hubbard FI, the odds of death were 1.49 (95% CI: 1.42-1.56) times higher. The association between frailty and mortality remained consistent in the post-vaccine period, but sex and age were partly attenuated. Despite the substantial home-level variation, no home-level characteristic examined was significantly associated with 30-day COVID-19 mortality during either period.
Interpretation: Frailty is consistently associated with COVID-19 mortality before and after the availability of SARS-CoV-2 vaccination. Home-level characteristics previously attributed to COVID-19 outcomes do not explain significant home-to-home variation in COVID-19 mortality.
Keywords: COVID-19; frailty; long-term care homes; multi-level models; older adults; older people.
. 2023 Dec 1;52(12):afad229.
doi: 10.1093/ageing/afad229. The association between frailty, long-term care home characteristics and COVID-19 mortality before and after SARS-CoV-2 vaccination: a retrospective cohort study
Darly Dash[SUP] 1 [/SUP], Fabrice I Mowbray[SUP] 2 [/SUP], Jeffrey W Poss[SUP] 3 [/SUP], Komal Aryal[SUP] 1 [/SUP], Nathan M Stall[SUP] 4 5 [/SUP], John P Hirdes[SUP] 3 [/SUP], Michael P Hillmer[SUP] 6 [/SUP], George A Heckman[SUP] 3 [/SUP], Dawn M E Bowdish[SUP] 7 8 [/SUP], Andrew P Costa[SUP] 1 7 [/SUP], Aaron Jones[SUP] 1 [/SUP]
Affiliations
- PMID: 38163287
- DOI: 10.1093/ageing/afad229
Background: The relative contributions of long-term care (LTC) resident frailty and home-level characteristics on COVID-19 mortality has not been well studied. We examined the association between resident frailty and home-level characteristics with 30-day COVID-19 mortality before and after the availability of SARS-CoV-2 vaccination in LTC.
Methods: We conducted a population-based retrospective cohort study of LTC residents with confirmed SARS-CoV-2 infection in Ontario, Canada. We used multi-level multivariable logistic regression to examine associations between 30-day COVID-19 mortality, the Hubbard Frailty Index (FI), and resident and home-level characteristics. We compared explanatory models before and after vaccine availability.
Results: There were 11,179 and 3,655 COVID-19 cases in the pre- and post-vaccine period, respectively. The 30-day COVID-19 mortality was 25.9 and 20.0% during the same periods. The median odds ratios for 30-day COVID-19 mortality between LTC homes were 1.50 (95% credible interval [CrI]: 1.41-1.65) and 1.62 (95% CrI: 1.46-1.96), respectively. In the pre-vaccine period, 30-day COVID-19 mortality was higher for males and those of greater age. For every 0.1 increase in the Hubbard FI, the odds of death were 1.49 (95% CI: 1.42-1.56) times higher. The association between frailty and mortality remained consistent in the post-vaccine period, but sex and age were partly attenuated. Despite the substantial home-level variation, no home-level characteristic examined was significantly associated with 30-day COVID-19 mortality during either period.
Interpretation: Frailty is consistently associated with COVID-19 mortality before and after the availability of SARS-CoV-2 vaccination. Home-level characteristics previously attributed to COVID-19 outcomes do not explain significant home-to-home variation in COVID-19 mortality.
Keywords: COVID-19; frailty; long-term care homes; multi-level models; older adults; older people.