Risk Factors Associated With All-Cause 30-Day Mortality in Nursing Home Residents With COVID-19
JAMA Intern Med. Published online January 4, 2021. doi:10.1001/jamainternmed.2020.7968
A good level of vitamin D decreases the nursing home COVID-19 death rate more than any of the factors listed in this study.
- Italian nursing home COVID-19 – 4X less likely to die if taking Vitamin D– Dec 22, 2020
- Residents of a Nursing Home who choose monthly Vitamin D had 4X fewer COVID-19 deaths – Nov 2, 2020
- Nursing homes could reduce risk of COVID-19 with Vitamin D – June 30, 2020
- 2.8 X fewer COVID-19 nursing home deaths if add 10,000 IU Vitamin D daily for a week (small observation)- Jan 2021
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Key Points
- Question What patient characteristics are associated with 30-day all-cause mortality among symptomatic nursing home residents with coronavirus disease 2019 (COVID-19)?
- Findings In this cohort study of 5256 US nursing home residents with COVID-19, increased age, male sex, and impaired cognitive and physical function were independent risk factors for all-cause 30-day mortality.
- Meaning This cohort study of 5256 nursing home residents suggests that several characteristics, including sociodemographic characteristics, symptoms, comorbidities, and physical and cognitive functional impairments, can facilitate risk stratification among nursing home residents with COVID-19.
Importance The coronavirus disease 2019 (COVID-19) pandemic has severely affected nursing homes. Vulnerable nursing home residents are at high risk for adverse outcomes, but improved understanding is needed to identify risk factors for mortality among nursing home residents.
Objective To identify risk factors for 30-day all-cause mortality among US nursing home residents with COVID-19.
Design, Setting, and Participants This cohort study was conducted at 351 US nursing homes among 5256 nursing home residents with COVID-19–related symptoms who had severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection confirmed by polymerase chain reaction testing between March 16 and September 15, 2020.
Exposures Resident-level characteristics, including age, sex, race/ethnicity, symptoms, chronic conditions, and physical and cognitive function.
Main Outcomes and Measures Death due to any cause within 30 days of the first positive SARS-CoV-2 test result.
Results The study included 5256 nursing home residents (3185 women [61%]; median age, 79 years [interquartile range, 69-88 years]; and 3741 White residents [71%], 909 Black residents [17%], and 586 individuals of other races/ethnicities [11%]) with COVID-19. Compared with residents aged 75 to 79 years, the odds of death were 1.46 (95% CI, 1.14-1.86) times higher for residents aged 80 to 84 years, 1.59 (95% CI, 1.25-2.03) times higher for residents aged 85 to 89 years, and 2.14 (95% CI, 1.70-2.69) times higher for residents aged 90 years or older. Women had lower risk for 30-day mortality than men (odds ratio [OR], 0.69 [95% CI, 0.60-0.80]). Two comorbidities were associated with mortality: diabetes (OR, 1.21 [95% CI, 1.05-1.40]) and chronic kidney disease (OR, 1.33 [95%, 1.11-1.61]). Fever (OR, 1.66 [95% CI, 1.41-1.96]), shortness of breath (OR, 2.52 [95% CI, 2.00-3.16]), tachycardia (OR, 1.31 [95% CI, 1.04-1.64]), and hypoxia (OR, 2.05 [95% CI, 1.68-2.50]) were also associated with increased risk of 30-day mortality. Compared with cognitively intact residents, the odds of death among residents with moderate cognitive impairment were 2.09 (95% CI, 1.68-2.59) times higher, and the odds of death among residents with severe cognitive impairment were 2.79 (95% CI, 2.14-3.66) times higher. Compared with residents with no or limited impairment in physical function, the odds of death among residents with moderate impairment were 1.49 (95% CI, 1.18-1.88) times higher, and the odds of death among residents with severe impairment were 1.64 (95% CI, 1.30-2.08) times higher.
Conclusions and Relevance In this cohort study of US nursing home residents with COVID-19, increased age, male sex, and impaired cognitive and physical function were independently associated with mortality. Understanding these risk factors can aid in the development of clinical prediction models of mortality in this population.