PDF(Pubmed)
Abstract：
Nursing homes are a primary setting of COVID-19 transmission and death, but research has primarily focused only on factors within nursing homes. We investigated the relationship between US nursing home-associated COVID-19 infection rates and county-level and nursing home attributes.
We constructed panel data from the Centers for Medicare & Medicaid Services (CMS) minimum dataset, CMS nursing home data, 2010 US Census data, 5-year (2012-2016) American Community Survey estimates, and county COVID-19 infection rates. We analyzed COVID-19 data from June 1, 2020, through January 31, 2021, during 7 five-week periods. We used a maximum likelihood estimator, including an autoregressive term, to estimate effects and changes over time. We performed 3 model forms (basic, partial, and full) for analysis.
Nursing homes with nursing (0.005) and staff (0.002) shortages had high COVID-19 infection rates, and locally owned (-0.007) or state-owned (-0.025) and nonprofit (-0.011) agencies had lower COVID-19 infection rates than privately owned agencies. County-level COVID-19 infection rates corresponded with COVID-19 infection rates in nursing homes. Racial and ethnic minority groups had high nursing home-associated COVID-19 infection rates early in the study. High median annual personal income (-0.002) at the county level correlated with lower nursing home-associated COVID-19 infection rates.
Communities with low rates of nursing home infections had access to more resources (eg, financial resources, staffing) and likely had better mitigation efforts in place earlier in the pandemic than nursing homes that had access to few resources and poor mitigation efforts. Future research should address the social and structural determinants of health that are leaving racial and ethnic minority populations and institutions such as nursing homes vulnerable during times of crises.
We constructed panel data from the Centers for Medicare & Medicaid Services (CMS) minimum dataset, CMS nursing home data, 2010 US Census data, 5-year (2012-2016) American Community Survey estimates, and county COVID-19 infection rates. We analyzed COVID-19 data from June 1, 2020, through January 31, 2021, during 7 five-week periods. We used a maximum likelihood estimator, including an autoregressive term, to estimate effects and changes over time. We performed 3 model forms (basic, partial, and full) for analysis.
Nursing homes with nursing (0.005) and staff (0.002) shortages had high COVID-19 infection rates, and locally owned (-0.007) or state-owned (-0.025) and nonprofit (-0.011) agencies had lower COVID-19 infection rates than privately owned agencies. County-level COVID-19 infection rates corresponded with COVID-19 infection rates in nursing homes. Racial and ethnic minority groups had high nursing home-associated COVID-19 infection rates early in the study. High median annual personal income (-0.002) at the county level correlated with lower nursing home-associated COVID-19 infection rates.
Communities with low rates of nursing home infections had access to more resources (eg, financial resources, staffing) and likely had better mitigation efforts in place earlier in the pandemic than nursing homes that had access to few resources and poor mitigation efforts. Future research should address the social and structural determinants of health that are leaving racial and ethnic minority populations and institutions such as nursing homes vulnerable during times of crises.
摘要：
疗养院是COVID-19传播和死亡的主要环境，但是研究主要只关注疗养院内的因素。我们调查了美国疗养院相关COVID-19感染率与县级和疗养院属性之间的关系。
我们从医疗保险和医疗补助服务中心(CMS)最小数据集构建了面板数据，CMS疗养院数据，2010年美国人口普查数据，5年(2012-2016年)美国社区调查估计，县COVID-19感染率。我们分析了2020年6月1日至2021年1月31日在7个五周期间的COVID-19数据。我们使用了最大似然估计器，包括一个自回归项，估计随时间的影响和变化。我们执行了3种模型形式(基本，局部,和完整)进行分析。
护理（0.005）和工作人员（0.002）短缺的疗养院的COVID-19感染率很高，本地（-0.007）或国有（-0.025）和非营利（-0.011）机构的COVID-19感染率低于私营机构。县级COVID-19感染率与养老院的COVID-19感染率相对应。在研究初期，种族和少数民族群体与疗养院相关的COVID-19感染率很高。县级个人年收入中位数较高（-0.002）与养老院相关的COVID-19感染率较低相关。
疗养院感染率低的社区可以获得更多资源（例如，财政资源,人员配备)，并且在大流行的早期可能比获得很少资源和较差缓解努力的疗养院有更好的缓解努力。未来的研究应解决健康的社会和结构决定因素，这些因素使种族和少数民族人口以及疗养院等机构在危机时期变得脆弱。
我们从医疗保险和医疗补助服务中心(CMS)最小数据集构建了面板数据，CMS疗养院数据，2010年美国人口普查数据，5年(2012-2016年)美国社区调查估计，县COVID-19感染率。我们分析了2020年6月1日至2021年1月31日在7个五周期间的COVID-19数据。我们使用了最大似然估计器，包括一个自回归项，估计随时间的影响和变化。我们执行了3种模型形式(基本，局部,和完整)进行分析。
护理（0.005）和工作人员（0.002）短缺的疗养院的COVID-19感染率很高，本地（-0.007）或国有（-0.025）和非营利（-0.011）机构的COVID-19感染率低于私营机构。县级COVID-19感染率与养老院的COVID-19感染率相对应。在研究初期，种族和少数民族群体与疗养院相关的COVID-19感染率很高。县级个人年收入中位数较高（-0.002）与养老院相关的COVID-19感染率较低相关。
疗养院感染率低的社区可以获得更多资源（例如，财政资源,人员配备)，并且在大流行的早期可能比获得很少资源和较差缓解努力的疗养院有更好的缓解努力。未来的研究应解决健康的社会和结构决定因素，这些因素使种族和少数民族人口以及疗养院等机构在危机时期变得脆弱。
