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Tytuł:
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Risk factors for outbreaks of COVID-19 in care homes following hospital discharge: A national cohort analysis.
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Autorzy:
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Emmerson C; Public Health Wales, Cardiff, UK.
Adamson JP; Public Health Wales, Cardiff, UK.
Turner D; Public Health Wales, Cardiff, UK.
Gravenor MB; Swansea University Medical School, Swansea, UK.
Salmon J; Public Health Wales, Cardiff, UK.
Cottrell S; Public Health Wales, Cardiff, UK.
Middleton V; Public Health Wales, Cardiff, UK.
Thomas B; Public Health Wales, Cardiff, UK.
Mason BW; Public Health Wales, Cardiff, UK.
Williams CJ; Public Health Wales, Cardiff, UK.
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Źródło:
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Influenza and other respiratory viruses [Influenza Other Respir Viruses] 2021 May; Vol. 15 (3), pp. 371-380. Date of Electronic Publication: 2021 Feb 06.
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Typ publikacji:
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Journal Article
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Język:
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English
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Imprint Name(s):
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Original Publication: Oxford, UK : Wiley, c2007-
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MeSH Terms:
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Disease Outbreaks*
Nursing Homes*
SARS-CoV-2*
COVID-19/*epidemiology
Cohort Studies ; Humans ; Patient Discharge ; Proportional Hazards Models
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References:
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J Public Health (Oxf). 2021 Jun 7;43(2):228-235. (PMID: 33367852)
J Infect. 2020 Sep;81(3):411-419. (PMID: 32504743)
BMJ. 2020 Jun 18;369:m2334. (PMID: 32554433)
Lancet Healthy Longev. 2020 Oct;1(1):e21-e31. (PMID: 34173614)
Bull Math Biol. 2020 Apr 8;82(4):52. (PMID: 32270376)
JAMA. 2020 Apr 7;323(13):1239-1242. (PMID: 32091533)
BMJ. 2020 Jun 12;369:m2375. (PMID: 32532803)
Influenza Other Respir Viruses. 2021 May;15(3):371-380. (PMID: 33547872)
Age Ageing. 2021 Jun 28;50(4):1019-1028. (PMID: 33710281)
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Contributed Indexing:
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Keywords: COVID-19 pandemic; care homes; hospital discharge; long-term care; outbreak; time-dependent Cox regression
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Entry Date(s):
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Date Created: 20210206 Date Completed: 20210505 Latest Revision: 20240331
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Update Code:
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20240331
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PubMed Central ID:
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PMC8013658
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DOI:
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10.1111/irv.12831
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PMID:
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33547872
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Background: The population of adult residential care homes has been shown to have high morbidity and mortality in relation to COVID-19.
Methods: We examined 3115 hospital discharges to a national cohort of 1068 adult care homes and subsequent outbreaks of COVID-19 occurring between 22 February and 27 June 2020. A Cox proportional hazards regression model was used to assess the impact of time-dependent exposure to hospital discharge on incidence of the first known outbreak, over a window of 7-21 days after discharge, and adjusted for care home characteristics, including size and type of provision.
Results: A total of 330 homes experienced an outbreak, and 544 homes received a discharge over the study period. Exposure to hospital discharge was not associated with a significant increase in the risk of a new outbreak (hazard ratio 1.15, 95% CI 0.89, 1.47, P = .29) after adjusting for care home characteristics. Care home size was the most significant predictor. Hazard ratios (95% CI) in comparison with homes of <10 residents were as follows: 3.40 (1.99, 5.80) for 10-24 residents; 8.25 (4.93, 13.81) for 25-49 residents; and 17.35 (9.65, 31.19) for 50+ residents. When stratified for care home size, the outbreak rates were similar for periods when homes were exposed to a hospital discharge, in comparison with periods when homes were unexposed.
Conclusion: Our analyses showed that large homes were at considerably greater risk of outbreaks throughout the epidemic, and after adjusting for care home size, a discharge from hospital was not associated with a significant increase in risk.
(© 2020 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.)
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