Predictors of Mortality Among Long-term Care Residents With SARS-CoV-2 Infection

Douglas S. Lee MD, PhD; Shihao Ma BASc; Anna Chu MHSc; Chloe X. Wang BSc; Xuesong Wang MSc; Peter C. Austin PhD; Finlay A. McAlister MD, MSc; Sunil V. Kalmady PhD; Moira K. Kapral MD, MSc; Padma Kaul PhD; Dennis T. Ko MD, MSc; Paula A. Rochon MD, MPH; Michael J. Schull MD, MSc; Barry B. Rubin MD, PhD; Bo Wang PhD


J Am Geriatr Soc. 2021;69(12):3377-3388. 

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Our study has several notable limitations. We did not have symptom information, however, asymptomatic transmission of SARS-CoV-2 can occur and atypical presentation of infection can also occur.[29] Therefore, it is still important to consider who is at high risk to enable implementation of preventive measures. We also did not have information on public versus for-profit homes, shared rooms and bathrooms, and other measures of LTC facility crowding. Earlier studies from Ontario suggest that residing in a for-profit versus public nursing home was associated with a 1.8-fold greater risk of death while high crowding was associated with a 1.7-fold higher risk.[30,31] In contrast, using our model covariates, which were mostly related to resident characteristics, there was a 12-fold higher risk in the highest quartile compared with the lowest quartile of risk. Other studies have also shown no differences in mortality at for-profit in comparison with publicly funded nursing homes after SARS-CoV-2 infection.[32] Moreover, while we were able to define duration of various comorbidities, we did not have data on severity. Finally, we did not have information on advanced directives. Nonetheless, the trajectory of deaths after SARS-CoV-2 infection were rapidly occurring and undesired outcomes.