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Risk factors for mortality of residents in nursing homes with Covid-19: a retrospective cohort study

Background Nursing homes have shown remarkably high Covid-19 incidence and mortality. We aimed to explore the contribution of structural factors of nursing home facilities and the surrounding district to all-cause and Covid-19-related deaths during a SARS-CoV-2 outbreak. Methods In this retrospective cohort study, we investigated the risk factors of Covid-19 mortality at the facility level in nursing homes in Catalonia (North-East Spain). The investigated factors included characteristics of the residents (age, gender, comorbidities, and complexity and/or advanced disease), structural features of the nursing home (total number of residents, residents who return home during the pandemic, and capacity for pandemic response, based on an ad hoc score of availability of twelve essential items for implementing preventive measures), and sociodemographic profile of the catchment district (household income, population density, and population incidence of Covid-19). Study endpoints included all-cause death and Covid-19-related death (either PCR-confirmed or clinical suspicion). Findings The analysis included 167 nursing homes that provide long-term care to 8,716 residents. Between March 1 and June 1, 2020, 1,629 deaths were reported in these nursing homes; 1,089 (66,9%) of them were Covid-19-confirmed. The multivariable regression showed a higher risk of death associated with a higher percentage of complex patients (HR 1,09; 95%CI 1,05 to 1,12 per 10% increase) or those with advanced diseases (1,13; 1,07 to 1,19), lower capacity for implementing preventive measures (1,08; 1,05 to 1,10 per 1-point increase), and districts with a higher incidence of Covid-19 (2,98; 2,53 to 3,50 per 1000 cases/100,000 population increase). A higher population density of the catchment area was a protective factor (0,60; 0,50 to 0,72 per log10 people/Km2 increase). Interpretation Presence of residents with complex/advance disease, low capacity for pandemic response and location in areas with high incidence of Covid-19 are risk factors for Covid-19 mortality in nursing homes and may help policymakers to prioritize preventative interventions for pandemic containment.