Mapping community-level determinants of COVID-19 transmission in nursing homes: A multi-scale approach

Deaths from the COVID-19 pandemic have disproportionately affected older adults and residents in nursing homes. Although emerging research has identified place-based risk factors for the general population, little research has been conducted for nursing home populations. This GIS-based spatial model...

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Bibliographic Details
Published in:The Science of the total environment 2021-01, Vol.752, p.141946-141946, Article 141946
Main Authors: Sugg, Margaret M., Spaulding, Trent J., Lane, Sandi J., Runkle, Jennifer D., Harden, Stella R., Hege, Adam, Iyer, Lakshmi S.
Format: Article
Language:English
Subjects:
Aged
Betacoronavirus
Coronavirus Infections - epidemiology
COVID-19
Cross-Sectional Studies
Humans
Income
Medicare
Multilevel models
Nursing Homes
Pandemics
Pneumonia, Viral - epidemiology
Population Density
Risk Factors
SARS-CoV-2
Spatial analysis
United States
Workforce
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Summary:Deaths from the COVID-19 pandemic have disproportionately affected older adults and residents in nursing homes. Although emerging research has identified place-based risk factors for the general population, little research has been conducted for nursing home populations. This GIS-based spatial modeling study aimed to determine the association between nursing home-level metrics and county-level, place-based variables with COVID-19 confirmed cases in nursing homes across the United States. A cross-sectional research design linked data from Centers for Medicare & Medicaid Services, American Community Survey, the 2010 Census, and COVID-19 cases among the general population and nursing homes. Spatial cluster analysis identified specific regions with statistically higher COVID-19 cases and deaths among residents. Multivariate analysis identified risk factors at the nursing home level including, total count of fines, total staffing levels, and LPN staffing levels. County-level or place-based factors like per-capita income, average household size, population density, and minority composition were significant predictors of COVID-19 cases in the nursing home. These results provide a framework for examining further COVID-19 cases in nursing homes and highlight the need to include other community-level variables when considering risk of COVID-19 transmission and outbreaks in nursing homes. [Display omitted] •Nursing home COVID-19 cases are clustered in the Northeast and Southeast US.•Community-level factors had the strongest association with nursing home cases.•Nursing home quality did not predict COVID-19 cases.
ISSN:0048-9697
1879-1026
DOI:10.1016/j.scitotenv.2020.141946