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Risk factors for outbreaks of COVID‐19 in care homes following hospital discharge: A national cohort analysis

Chris Emmerson, James P. Adamson, Drew Turner, Michael Gravenor Orcid Logo, Jane Salmon, Simon Cottrell, Victoria Middleton, Buffy Thomas, Brendan W. Mason, Chris J. Williams

Influenza and Other Respiratory Viruses, Volume: 15, Issue: 3, Pages: 371 - 380

Swansea University Author: Michael Gravenor Orcid Logo

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DOI (Published version): 10.1111/irv.12831

Abstract

BackgroundThe population of adult residential care homes has been shown to have high morbidity and mortality in relation to COVID-19.MethodsWe 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 Jun...

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Published in: Influenza and Other Respiratory Viruses
ISSN: 1750-2640 1750-2659
Published: Wiley 2021
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URI: https://cronfa.swan.ac.uk/Record/cronfa57776
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fullrecord <?xml version="1.0"?><rfc1807><datestamp>2022-10-27T10:52:46.8479475</datestamp><bib-version>v2</bib-version><id>57776</id><entry>2021-09-06</entry><title>Risk factors for outbreaks of COVID&#x2010;19 in care homes following hospital discharge: A national cohort analysis</title><swanseaauthors><author><sid>70a544476ce62ba78502ce463c2500d6</sid><ORCID>0000-0003-0710-0947</ORCID><firstname>Michael</firstname><surname>Gravenor</surname><name>Michael Gravenor</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2021-09-06</date><deptcode>HDAT</deptcode><abstract>BackgroundThe population of adult residential care homes has been shown to have high morbidity and mortality in relation to COVID-19.MethodsWe 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.ResultsA 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 &lt;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.ConclusionOur 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.</abstract><type>Journal Article</type><journal>Influenza and Other Respiratory Viruses</journal><volume>15</volume><journalNumber>3</journalNumber><paginationStart>371</paginationStart><paginationEnd>380</paginationEnd><publisher>Wiley</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>1750-2640</issnPrint><issnElectronic>1750-2659</issnElectronic><keywords>care homes; COVID-19 pandemic; hospital discharge; long-term care; outbreak; time-dependent Cox regression</keywords><publishedDay>1</publishedDay><publishedMonth>5</publishedMonth><publishedYear>2021</publishedYear><publishedDate>2021-05-01</publishedDate><doi>10.1111/irv.12831</doi><url/><notes/><college>COLLEGE NANME</college><department>Health Data Science</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>HDAT</DepartmentCode><institution>Swansea University</institution><apcterm>Another institution paid the OA fee</apcterm><funders/><projectreference/><lastEdited>2022-10-27T10:52:46.8479475</lastEdited><Created>2021-09-06T12:43:52.7377559</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Medicine</level></path><authors><author><firstname>Chris</firstname><surname>Emmerson</surname><order>1</order></author><author><firstname>James P.</firstname><surname>Adamson</surname><order>2</order></author><author><firstname>Drew</firstname><surname>Turner</surname><order>3</order></author><author><firstname>Michael</firstname><surname>Gravenor</surname><orcid>0000-0003-0710-0947</orcid><order>4</order></author><author><firstname>Jane</firstname><surname>Salmon</surname><order>5</order></author><author><firstname>Simon</firstname><surname>Cottrell</surname><order>6</order></author><author><firstname>Victoria</firstname><surname>Middleton</surname><order>7</order></author><author><firstname>Buffy</firstname><surname>Thomas</surname><order>8</order></author><author><firstname>Brendan W.</firstname><surname>Mason</surname><order>9</order></author><author><firstname>Chris J.</firstname><surname>Williams</surname><order>10</order></author></authors><documents><document><filename>57776__21147__42d983ac16b2419db8d2a5db7cf17ae9.pdf</filename><originalFilename>57776.pdf</originalFilename><uploaded>2021-10-12T15:18:33.4385917</uploaded><type>Output</type><contentLength>749377</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>&#xA9; 2020 The Authors. 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spelling 2022-10-27T10:52:46.8479475 v2 57776 2021-09-06 Risk factors for outbreaks of COVID‐19 in care homes following hospital discharge: A national cohort analysis 70a544476ce62ba78502ce463c2500d6 0000-0003-0710-0947 Michael Gravenor Michael Gravenor true false 2021-09-06 HDAT BackgroundThe population of adult residential care homes has been shown to have high morbidity and mortality in relation to COVID-19.MethodsWe 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.ResultsA 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.ConclusionOur 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. Journal Article Influenza and Other Respiratory Viruses 15 3 371 380 Wiley 1750-2640 1750-2659 care homes; COVID-19 pandemic; hospital discharge; long-term care; outbreak; time-dependent Cox regression 1 5 2021 2021-05-01 10.1111/irv.12831 COLLEGE NANME Health Data Science COLLEGE CODE HDAT Swansea University Another institution paid the OA fee 2022-10-27T10:52:46.8479475 2021-09-06T12:43:52.7377559 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Chris Emmerson 1 James P. Adamson 2 Drew Turner 3 Michael Gravenor 0000-0003-0710-0947 4 Jane Salmon 5 Simon Cottrell 6 Victoria Middleton 7 Buffy Thomas 8 Brendan W. Mason 9 Chris J. Williams 10 57776__21147__42d983ac16b2419db8d2a5db7cf17ae9.pdf 57776.pdf 2021-10-12T15:18:33.4385917 Output 749377 application/pdf Version of Record true © 2020 The Authors. This is an open access article under the terms of the Creative Commons Attribution License true eng http://creativecommons.org/licenses/by/4.0/
title Risk factors for outbreaks of COVID‐19 in care homes following hospital discharge: A national cohort analysis
spellingShingle Risk factors for outbreaks of COVID‐19 in care homes following hospital discharge: A national cohort analysis
Michael Gravenor
title_short Risk factors for outbreaks of COVID‐19 in care homes following hospital discharge: A national cohort analysis
title_full Risk factors for outbreaks of COVID‐19 in care homes following hospital discharge: A national cohort analysis
title_fullStr Risk factors for outbreaks of COVID‐19 in care homes following hospital discharge: A national cohort analysis
title_full_unstemmed Risk factors for outbreaks of COVID‐19 in care homes following hospital discharge: A national cohort analysis
title_sort Risk factors for outbreaks of COVID‐19 in care homes following hospital discharge: A national cohort analysis
author_id_str_mv 70a544476ce62ba78502ce463c2500d6
author_id_fullname_str_mv 70a544476ce62ba78502ce463c2500d6_***_Michael Gravenor
author Michael Gravenor
author2 Chris Emmerson
James P. Adamson
Drew Turner
Michael Gravenor
Jane Salmon
Simon Cottrell
Victoria Middleton
Buffy Thomas
Brendan W. Mason
Chris J. Williams
format Journal article
container_title Influenza and Other Respiratory Viruses
container_volume 15
container_issue 3
container_start_page 371
publishDate 2021
institution Swansea University
issn 1750-2640
1750-2659
doi_str_mv 10.1111/irv.12831
publisher Wiley
college_str Faculty of Medicine, Health and Life Sciences
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hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
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description BackgroundThe population of adult residential care homes has been shown to have high morbidity and mortality in relation to COVID-19.MethodsWe 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.ResultsA 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.ConclusionOur 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.
published_date 2021-05-01T04:13:46Z
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