ABSTRACT
The COVID-19 pandemic has disproportionately impacted older adults living in long-term care facilities (LTCFs), but little research has described parallel infection rates and mortality among LTCF residents and staff in relation to state-level mitigation measures. This study used comprehensive COVID-19 tracking data from the South Carolina Department of Health and Environmental Control (SCDHEC), including case report information on demographics, symptoms, comorbidities, and employment. We included all confirmed or probable COVID-19 cases and deaths among adult SC residents reported between 3/15/2020 and 1/2/2021. Residence or employment in LTCF, including nursing homes, assisted living, or skilled nursing facilities, were confirmed by SCDHEC. Cox proportional hazards models were used to compare mortality between residents/staff and counterparts in the community. Overall, 54,514 cases of COVID-19 were identified among older adults in SC. Of these, 13.5% (n = 7,366) resided in a LTCF. LTCF residents with COVID-19 were more likely to be hospitalized compared to older adults in the community and 74% more likely to die (HR= 1.74, 95% CI: 1.59-1.90), after controlling for age, gender, race, and chronic health conditions. LTCF staff had greater infection rates but lower risk of mortality (HR=0.58;95% CI: 0.39-0.88) compared to the general population. Differences in COVID-19 incidence and mortality between residents/staff and the community decreased after statewide mitigation policies. This study indicates that LTCF residents are at increased risk of COVID infection and mortality, even accounting for pre-existing health conditions. LTCF settings are key sites for prioritizing prevention, vaccination, and training plans to prepare for future pandemics.
ABSTRACT
OBJECTIVES: This study explored differences in COVID-19 incidence, mortality, and timing among long-term care facility (LTCF) residents and staff with those living in the community in South Carolina (SC). DESIGN: Longitudinal secondary data analysis. SETTING AND PARTICIPANTS: Adults age ≥18 in SC with confirmed COVID-19 diagnosis from 3/15/2020 and 1/2/2021 (n = 307,891). METHODS: COVID-19 data came from the SC Department of Health and Environmental Control (SCDHEC). We included all COVID-19 cases, hospitalizations, and deaths among adult residents. Residence and employment in LTCF were confirmed by SCDHEC. Descriptive statistics and trends for cases, hospitalizations, and deaths were calculated. We used Cox proportional hazards to compare COVID-19 mortality in LTCF residents and staff to community dwelling older adults and adults not employed in LTCF, respectively, controlling for age, gender, race, and pre-existing chronic health conditions. RESULTS: LTC residents experienced greater incidence of cases throughout the study period until the week ending on 1/2/21. LTCF residents with COVID-19 were more likely to be hospitalized compared to older adults in the community and 74% more likely to die (HR: 1.74, 95% CI: 1.59-1.90), after adjusting. LTC staff experienced greater incidence of cases compared to adults not employed in LTCF until the week ending on 12/26/2020, while experiencing similar incidence of death compared to the similar community members. After adjusting, LTC staff had 0.58 (HR = 0.58; CI: 0.39-0.88) times lower hazard of death compared to community members that did not work in a LTCF. CONCLUSIONS AND IMPLICATIONS: Narrowing of the gap between LTCF and community-wide infection and mortality rates over the study period suggests that early detection of COVID-19 in LTCFs could serve as a first indicator of disease spread in the greater community. Results also indicate that policies and regulations addressing staff testing and protection may help to slow or prevent spread within facilities.