Long-Term Care Home Size Association with COVID-19 Infection and Mortality in Catalonia in March and April 2020

• Published in: Epidemiolgia (Basel, Switzerland) Vol. 3; no. 3; pp. 369 - 390
• Main Authors: Zunzunegui, Maria Victoria, Béland, François, Rico, Manuel, López, Fernando J García
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 05.09.2022
• Subjects: Coronaviruses; COVID-19; COVID-19 incidence; COVID-19 mortality; Infections; Long term health care; long-term care; Mortality; Nonprofit organizations; Older people; Pandemics; Population; Public private partnerships; risk factors; Severe acute respiratory syndrome coronavirus 2; Catalonia Spain; Spain; COVID-19 mortality; risk factors; COVID-19 incidence; long-term care
• ISSN: 2673-3986; 2673-3986
• DOI: 10.3390/epidemiologia3030029

We aim to assess how COVID-19 infection and mortality varied according to facility size in 965 long-term care homes (LTCHs) in Catalonia during March and April 2020. We measured LTCH size by the number of authorised beds. Outcomes were COVID-19 infection (at least one COVID-19 case in an LTCH) and COVID-19 mortality. Risks of these were estimated with logistic regression and hurdle models. Models were adjusted for county COVID-19 incidence and population, and LTCH types. Sixty-five per cent of the LTCHs were infected by COVID-19. We found a strong association between COVID-19 infection and LTCH size in the adjusted analysis (from 45% in 10-bed homes to 97.5% in those with over 150 places). The average COVID-19 mortality in all LTCHs was 6.8% (3887 deaths) and 9.2% among the COVID-19-infected LTCHs. Very small and large homes had higher COVID-19 mortality, whereas LTCHs with 30 to 70 places had the lowest level. COVID-19 mortality sharply increased with LTCH size in counties with a cumulative incidence of COVID-19 which was higher than 250/100,000, except for very small homes, but slightly decreased with LTCH size when the cumulative incidence of COVID-19 was lower. To prevent infection and preserve life, the optimal size of an LTCH should be between 30 and 70 places.