Abstract
Background: COVID-19 vaccinations have been prioritised for high risk individuals.
Aim: Determine individual-level risk factors for care home residents testing positive for SARS-CoV-2.
Study design: Longitudinal observational cohort study using individual-level linked data from the Secure Anonymised Information Linkage (SAIL) databank.
Setting: Fourteen thousand seven hundred and eighty-six older care home residents (aged 65+) living in Wales between 1 September 2020 and 1 May 2021. Our dataset consisted of 2,613,341 individual-level daily observations within 697 care homes.
Methods: We estimated odds ratios (ORs [95% confidence interval]) using multilevel logistic regression models. Our outcome of interest was a positive SARS-CoV-2 PCR test. We included time-dependent covariates for the estimated community positive test rate of COVID-19, hospital inpatient status, vaccination status and frailty. Additional covariates were included for age, sex and specialist care home services.
Results: The multivariable regression model indicated an increase in age (OR 1.01 [1.00,1.01] per year), community positive test rate (OR 1.13 [1.12,1.13] per percent increase), hospital inpatients (OR 7.40 [6.54,8.36]), and residents in care homes with non-specialist dementia care (OR 1.42 [1.01,1.99]) had an increased odds of a positive test. Having a positive test prior to the observation period (OR 0.58 [0.49,0.68]) and either one or two doses of a vaccine (0.21 [0.17,0.25] and 0.05 [0.02,0.09], respectively) were associated with a decreased odds.
Conclusions: Care providers need to remain vigilant despite the vaccination rollout, and extra precautions should be taken when caring for the most vulnerable. Minimising potential COVID-19 infection for care home residents when admitted to hospital should be prioritised.
Keywords: COVID-19; PCR tests; care homes; hospital infection; older people; vaccination.
【저자키워드】 COVID-19, older people, vaccination., care homes, Hospital infection, PCR tests, 【초록키워드】 SARS-CoV-2, Vaccine, vaccination, hospital, frailty, Sex, outcome, risk factor, Dementia, PCR, COVID-19 vaccination, COVID-19 infection, Regression model, Community, age, dataset, longitudinal, Precaution, Care, linkage, dose, Odds ratio, high risk, care provider, observation, Inpatient, Observational cohort study, Older, observation period, Positive test, covariate, logistic regression models, positive, positive SARS-CoV-2 PCR, inpatient status, Seven, multivariable, indicated, increase in, individuals, Minimising, 【제목키워드】 vaccination, risk factor, Community, Care, longitudinal analysis, Hospital stay, Positive test,