Table 2_The impact of COVID-19 hospitalizations on nursing home admissions: a regional insight into long-term care and public health.docx

BackgroundTo obtain the rate of admission to nursing homes (NHs) and to evaluate clinical characteristics and mortality rates of patients admitted to NHs after hospitalizations for COVID-19, compared to non-COVID-19 acutely hospitalized patients.
MethodsWe analyzed administrative data from Lombardy, a Northen Italian region, in individuals aged ≥50 years who were hospitalized and discharged alive in 2018 for acute conditions or, between February 2020 and June 2022, for COVID-19. Outcomes included NH institutionalization rates within 180 post-discharge day and mortality following NH admission. Kaplan–Meier curves and Cox proportional hazard models adjusted for age, sex, and comorbidities were used to assess the risks.
ResultsAmong 133,216 COVID-19 hospitalizations in 2020–2022 and 239,099 acute hospitalizations in 2018, institutionalization rates within 180 post-discharge days were similar (3.7% for both cohorts). However, COVID-19 patients had higher adjusted risks of institutionalization (HR 1.70; 95% CI 1.63–1.78) and mortality within 6 months after NH admission (HR 2.08; 95% CI 1.90–2.27). Differences were more pronounced when considering patients hospitalized during the first COVID-19 pandemic wave.
ConclusionCOVID-19 hospitalization significantly increases the risks of admission to NHs and early mortality after institutionalization in older individuals compared to hospitalizations due to other acute conditions.

背景：为获取疗养院（nursing homes, NHs）入院率，并对比新型冠状病毒肺炎（COVID-19）住院患者与非COVID-19急性住院患者出院后入住疗养院的临床特征及死亡率，本研究开展相关分析。方法：本研究分析了意大利北部伦巴第大区的行政数据，研究对象为2018年因急性疾病住院且存活出院的50岁及以上个体，以及2020年2月至2022年6月因COVID-19住院且存活出院的50岁及以上个体。研究结局包括出院后180天内的疗养院入住率，以及入住疗养院后的死亡率。采用校正了年龄、性别与合并症的卡普兰-迈耶（Kaplan–Meier）曲线及Cox比例风险模型评估相关风险。结果：2020-2022年共有133216例COVID-19住院病例，2018年共有239099例急性疾病住院病例，两组人群出院后180天内的疗养院入住率相近（均为3.7%）。但经校正后，COVID-19患者的疗养院入住风险（风险比HR=1.70；95%置信区间CI：1.63~1.78）及入住疗养院后6个月内的死亡率风险（HR=2.08；95%CI：1.90~2.27）均更高。若仅考虑首次COVID-19大流行波次期间住院的患者，上述差异更为显著。结论：与因其他急性疾病住院的老年患者相比，COVID-19住院显著增加老年个体入住疗养院的风险，以及入住疗养院后的早期死亡风险。