Risk factors for outbreaks of SARS-CoV-2 infection at retirement homes in Ontario, Canada: a population-level cohort study

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 fi...

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Bibliographic Details
Published in:Canadian Medical Association journal (CMAJ) Vol. 193; no. 19; pp. E672 - E680
Main Authors: Costa, Andrew P., Manis, Derek R., Jones, Aaron, Stall, Nathan M., Brown, Kevin A., Boscart, Veronique, Castellino, Adriane, Heckman, George A., Hillmer, Michael P., Ma, Chloe, Pham, Paul, Rais, Saad, Sinha, Samir K., Poss, Jeffrey W.
Format: Journal Article
Language:English
Published: Canada Elsevier Inc 10.05.2021
CMA Joule Inc
CMA Impact, Inc
Subjects:
Assisted living facilities
Canada
Cohort analysis
Coronaviruses
COVID-19
Epidemics
Epidemiology
Fatalities
Health aspects
Infections
Information systems
Internal Medicine
Licenses
Long term health care
Older people
Pandemics
Population
Public health
Retirement homes
Risk factors
Severe acute respiratory syndrome coronavirus 2
Statistics
Canada
Ontario Canada
United States > US
ISSN:0820-3946, 1488-2329, 1488-2329
Online Access:Get full text
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Summary: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. 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. 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. 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.
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ISSN:0820-3946
1488-2329
1488-2329
DOI:10.1503/cmaj.202756