Flow diagram of the selection of the study population. Thus, the objective of this study was to analyze differences in the cumulative incidence (CI) and mortality rate (MR) of COVID-19 between the NHs of the city of Barcelona, according to their socioeconomic, functional, and structural variables.įig 1. Acknowledging the profile of the most affected NHs and their associated factors will make it possible to improve prevention and control measures in these centers. Given the high incidence and mortality rates due to COVID-19 in NHs in the city of Barcelona during the first wave of the current pandemic, it is essential to understand which characteristics of the NHs are related to a greater probability of being affected by COVID-19. All this added to the axes of social inequality such as age, territory, or social class may explain that the distribution of the COVID-19 epidemic has been concentrated in this group with greater frequency and severity than in other population segments. Structural and functional characteristics of NHs, such as sharing common spaces, having frequent contacts with the same healthcare personnel, housing a large number of frail elderly people sharing a room, difficulties of sectorization and isolation and even the ownership of these institutions are determining factors that may increase the risk of infection by COVID-19. It has been shown that the risk of morbidity and mortality in NHs are heterogeneous according to the characteristics of the residents and the institutions. As for older people, for the general population and for residents of 90 or more years old, the CI was 1,244 and 18,468, and the mortality rate was 701 and 5,279, respectively. Regarding mortality per 100,000 inhabitants, during the same period, the highest rate for the same age group was 200 in the general population, and 2,094 in residents of NHs, a value also more than 10 times higher. In Barcelona, since the beginning of the pandemic until the end of June, the highest cumulative incidence (CI) at 14 days per 100,000 inhabitants for the age group of 80–89 years old, was 902 in the general population (non-institutionalized elderly), while in the elderly living in NHs, it was 12,775, a CI more than 10 times higher. In terms of mortality, there were 3,965 deaths (confirmed and suspected cases) in the NHs, which accounted for 33% of all deaths in Catalonia due to this cause. From the start of the pandemic until June 1, around 36,500 people living in NHs had been suspected of having COVID-19 and almost 14,000 had been confirmed, implying that approximately 80% of the elderly who lived in NHs could have suffered from the disease. In Catalonia there were more than 64,000 people living in NHs in 2020 with a mean age of 83 years old. By May, in Canada more than 80% of all COVID-19 deaths occurred in NHs, while in Europe, almost half of all deaths were occurring in NHs in several countries, where long-term care facilities, including NHs, registered 26 to 66% of all COVID-19 deaths. Also, since the beginning of the pandemic, COVID-19 outbreaks in NHs have accounted for the high mortality worldwide. In the USA, in the same period, of 13,709 NHs, 39% reported at least one case. In an English study accounting of 9,000 NHs on the first wave of the pandemic, more than half of the NHs reported at least one confirmed case. In 2020, elderly people, especially those living in NHs, were particularly affected by COVID-19. Previous studies show that NHs are not fully prepared for respiratory virus outbreaks, with some cases reporting that even routine infection control measures or vaccination were not enough to prevent illness, complications and deaths. īefore COVID-19 pandemic, influenza and other viruses such as parainfluenza, rhinovirus, adenovirus, metapneumovirus, other coronaviruses, and respiratory syncytial virus, have been described as outbreaks pathogens in NHs. The conditions of these facilities and the susceptibility of their residents provide an environment conducive to the rapid spread of respiratory pathogens that can enter to the NHs by their staff, visitors and new or transferred residents and once inside, spread rapidly among residents. NHs present a series of characteristics that expose residents to an increased risk of respiratory diseases and outbreaks. This demographic change is giving way to an increase in the elderly population, which implies a higher prevalence of chronic diseases and frailty, resulting in the loss of autonomy and assuming an increase in the demand for services such as nursing homes for the elderly (NHs). The progressive aging of the population is magnifying the health, social and economic consequences for today’s society.
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