Impaired cognition and physical impairment tied to higher death rates in COVID-19: JAMA
USA: Physical and cognitive impairments, male sex and older age are tied to higher risk of death in COVID-19 patients, show results from a cohort study of US nursing home residents. The study is published in the journal JAMA Internal Medicine.
The coronavirus disease 2019 (COVID-19) pandemic which has engulfed the entire world, has severely affected nursing homes. Vulnerable nursing home residents seems to be at higher risk of adverse outcomes of the viral infection but there is a need for improved understanding for identifying risk factors for mortality among nursing home residents.
Considering this, Orestis A. Panagiotou, Brown University School of Public Health, Providence, Rhode Island, and colleagues aimed to identify risk factors for 30-day all-cause mortality among US nursing home residents with COVID-19.
For the purpose, the researchers performed this cohort study at 351 US nursing homes among 5256 nursing home residents with COVID-19–related symptoms who had severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection confirmed by polymerase chain reaction testing between March 16 and September 15, 2020. It included 5256 nursing home residents (3185 women [61%]); 3741 White residents [71%], 909 Black residents [17%], and 586 individuals of other races/ethnicities [11%]) with COVID-19.
Primary outcome was death due to any cause within 30 days of the first positive SARS-CoV-2 test result.
Key findings of the study include:
- Compared with residents aged 75 to 79 years, the odds of death were 1.46 times higher for residents aged 80 to 84 years, 1.59 times higher for residents aged 85 to 89 years, and 2.14 times higher for residents aged 90 years or older.
- Women had lower risk for 30-day mortality than men (odds ratio [OR], 0.69).
- Two comorbidities were associated with mortality: diabetes (OR, 1.21) and chronic kidney disease (OR, 1.33).
- Fever (OR, 1.66), shortness of breath (OR, 2.52), tachycardia (OR, 1.31), and hypoxia (OR, 2.05) were also associated with increased risk of 30-day mortality.
- Compared with cognitively intact residents, the odds of death among residents with moderate cognitive impairment were 2.09 times higher, and the odds of death among residents with severe cognitive impairment were 2.79 times higher.
- Compared with residents with no or limited impairment in physical function, the odds of death among residents with moderate impairment were 1.49 times higher, and the odds of death among residents with severe impairment were 1.64 times higher.
"Our study results showed that increased age, male sex, and impaired cognitive and physical function are independently associated with mortality in US nursing home residents with COVID-19. Understanding these risk factors can aid in the development of clinical prediction models of mortality in this population," concluded the authors.
The study, "Risk Factors Associated With All-Cause 30-Day Mortality in Nursing Home Residents With COVID-19," is published in the journal JAMA Internal Medicine.
DOI: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2774729
