Andrew P Costa1, Derek R Manis2, Aaron Jones2, Nathan M Stall2, Kevin A Brown2, Veronique Boscart2, Adriane Castellino2, George A Heckman2, Michael P Hillmer2, Chloe Ma2, Paul Pham2, Saad Rais2, Samir K Sinha2, Jeffrey W Poss2. 1. Department of Health Research Methods, Evidence, and Impact (Costa, Manis, Jones, Poss), Department of Medicine (Costa), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont.; Schlegel Research Institute for Aging (Costa, Boscart, Heckman), Waterloo, Waterloo, Ont.; Institute for Clinical Evaluative Sciences (IC/ES) (Costa, Jones, Stall), Toronto, Ont.; Centre for Health Economics and Policy Analyses (Costa, Manis), St. Joseph's Health System, Hamilton, Ont.; Division of General Internal Medicine and Geriatric Medicine (Stall, Sinha), Sinai Health and University Health Network; Department of Medicine (Stall, Sinha), University of Toronto; Institute of Health Policy, Management and Evaluation (Stall, Hillmer, Sinha), University of Toronto; Women's College Research Institute, Women's College Hospital (Stall); National Institute on Ageing, Ryerson University (Stall, Sinha); Infection Prevention and Control (Brown), Public Health Ontario; Dalla Lana School of Public Health (Brown), University of Toronto, Toronto, Ont.; Conestoga College Institute of Technology and Advanced Learning (Boscart), Kitchener, Ont.; Retirement Homes Regulatory Authority (RHRA) (Castellino, Ma, Pham), Toronto, Ont.; School of Public Health and Health Systems (Heckman, Poss), University of Waterloo, Waterloo, Ont.; Capacity Planning and Analytics (Hillmer, Rais), Ontario Ministry of Health, Toronto, Ont. acosta@mcmaster.ca. 2. Department of Health Research Methods, Evidence, and Impact (Costa, Manis, Jones, Poss), Department of Medicine (Costa), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont.; Schlegel Research Institute for Aging (Costa, Boscart, Heckman), Waterloo, Waterloo, Ont.; Institute for Clinical Evaluative Sciences (IC/ES) (Costa, Jones, Stall), Toronto, Ont.; Centre for Health Economics and Policy Analyses (Costa, Manis), St. Joseph's Health System, Hamilton, Ont.; Division of General Internal Medicine and Geriatric Medicine (Stall, Sinha), Sinai Health and University Health Network; Department of Medicine (Stall, Sinha), University of Toronto; Institute of Health Policy, Management and Evaluation (Stall, Hillmer, Sinha), University of Toronto; Women's College Research Institute, Women's College Hospital (Stall); National Institute on Ageing, Ryerson University (Stall, Sinha); Infection Prevention and Control (Brown), Public Health Ontario; Dalla Lana School of Public Health (Brown), University of Toronto, Toronto, Ont.; Conestoga College Institute of Technology and Advanced Learning (Boscart), Kitchener, Ont.; Retirement Homes Regulatory Authority (RHRA) (Castellino, Ma, Pham), Toronto, Ont.; School of Public Health and Health Systems (Heckman, Poss), University of Waterloo, Waterloo, Ont.; Capacity Planning and Analytics (Hillmer, Rais), Ontario Ministry of Health, Toronto, Ont.
Abstract
BACKGROUND: The epidemiology of SARS-CoV-2 infection in retirement homes (also known as assisted living facilities) is largely unknown. We examined the association between home-and community-level characteristics and the risk of outbreaks of SARS-CoV-2 infection in retirement homes since the beginning of the first wave of the COVID-19 pandemic. METHODS: We conducted a population-based, retrospective cohort study of licensed retirement homes in Ontario, Canada, from Mar. 1 to Dec. 18, 2020. Our primary outcome was an outbreak of SARS-CoV-2 infection (≥ 1 resident or staff case confirmed by validated nucleic acid amplification assay). We used time-dependent proportional hazards methods to model the associations between retirement home- and community-level characteristics and outbreaks of SARS-CoV-2 infection. RESULTS: Our cohort included all 770 licensed retirement homes in Ontario, which housed 56 491 residents. There were 273 (35.5%) retirement homes with 1 or more outbreaks of SARS-CoV-2 infection, involving 1944 (3.5%) residents and 1101 staff (3.0%). Cases of SARS-CoV-2 infection were distributed unevenly across retirement homes, with 2487 (81.7%) resident and staff cases occurring in 77 (10%) homes. The adjusted hazard of an outbreak of SARS-CoV-2 infection in a retirement home was positively associated with homes that had a large resident capacity, were co-located with a long-term care facility, were part of larger chains, offered many services onsite, saw increases in regional incidence of SARS-CoV-2 infection, and were located in a region with a higher community-level ethnic concentration. INTERPRETATION: Readily identifiable characteristics of retirement homes are independently associated with outbreaks of SARS-CoV-2 infection and can support risk identification and priority for vaccination.
BACKGROUND: The epidemiology of SARS-CoV-2 infection in retirement homes (also known as assisted living facilities) is largely unknown. We examined the association between home-and community-level characteristics and the risk of outbreaks of SARS-CoV-2 infection in retirement homes since the beginning of the first wave of the COVID-19 pandemic. METHODS: We conducted a population-based, retrospective cohort study of licensed retirement homes in Ontario, Canada, from Mar. 1 to Dec. 18, 2020. Our primary outcome was an outbreak of SARS-CoV-2 infection (≥ 1 resident or staff case confirmed by validated nucleic acid amplification assay). We used time-dependent proportional hazards methods to model the associations between retirement home- and community-level characteristics and outbreaks of SARS-CoV-2 infection. RESULTS: Our cohort included all 770 licensed retirement homes in Ontario, which housed 56 491 residents. There were 273 (35.5%) retirement homes with 1 or more outbreaks of SARS-CoV-2 infection, involving 1944 (3.5%) residents and 1101 staff (3.0%). Cases of SARS-CoV-2 infection were distributed unevenly across retirement homes, with 2487 (81.7%) resident and staff cases occurring in 77 (10%) homes. The adjusted hazard of an outbreak of SARS-CoV-2 infection in a retirement home was positively associated with homes that had a large resident capacity, were co-located with a long-term care facility, were part of larger chains, offered many services onsite, saw increases in regional incidence of SARS-CoV-2 infection, and were located in a region with a higher community-level ethnic concentration. INTERPRETATION: Readily identifiable characteristics of retirement homes are independently associated with outbreaks of SARS-CoV-2 infection and can support risk identification and priority for vaccination.
Authors: Susan E Bronskill; Laura C Maclagan; Colleen J Maxwell; Andrea Iaboni; R Liisa Jaakkimainen; Connie Marras; Xuesong Wang; Jun Guan; Daniel A Harris; Abby Emdin; Aaron Jones; Nadia Sourial; Claire Godard-Sebillotte; Isabelle Vedel; Peter C Austin; Richard H Swartz Journal: JAMA Health Forum Date: 2022-01-21
Authors: Laura C Maclagan; Xuesong Wang; Abby Emdin; Aaron Jones; R Liisa Jaakkimainen; Michael J Schull; Nadia Sourial; Isabelle Vedel; Richard H Swartz; Susan E Bronskill Journal: CMAJ Open Date: 2022-07-05
Authors: Adam H Dyer; Aoife Fallon; Claire Noonan; Helena Dolphin; Cliona O'Farrelly; Nollaig M Bourke; Desmond O'Neill; Sean P Kennelly Journal: J Am Med Dir Assoc Date: 2022-07-04 Impact factor: 7.802
Authors: Derek R Manis; Jeffrey W Poss; Aaron Jones; Paula A Rochon; Susan E Bronskill; Michael A Campitelli; Richard Perez; Nathan M Stall; Ahmad Rahim; Glenda Babe; Jean-Éric Tarride; Julia Abelson; Andrew P Costa Journal: CMAJ Date: 2022-05-30 Impact factor: 16.859