Abstract Background COVID-19 severely impacted older adults and long-term care facility (LTCF) residents. Our primary aim was to describe differences in clinical and epidemiological variables, in-hospital management, and outcomes between LTCF residents and community-dwelling older adults hospitalized with COVID-19. The secondary aim was to identify risk factors for mortality due to COVID-19 in hospitalized LTCF residents. Methods This is a cross-sectional analysis within a retrospective cohort of hospitalized patients ≥75 years with confirmed COVID-19 admitted to 160 Spanish hospitals. Differences between groups and factors associated with mortality among LTCF residents were assessed through comparisons and logistic regression analysis. Results Of 6 189 patients ≥75 years, 1 185 (19.1%) were LTCF residents and 4 548 (73.5%) were community-dwelling. LTCF residents were older (median: 87.4 vs 82.1 years), mostly female (61.6% vs 43.2%), had more severe functional dependence (47.0% vs 7.8%), more comorbidities (Charlson Comorbidity Index: 6 vs 5), had dementia more often (59.1% vs 14.4%), and had shorter duration of symptoms (median: 3 vs 6 days) than community-dwelling patients (all, p < .001). Mortality risk factors in LTCF residents were severe functional dependence (adjusted odds ratios [aOR]: 1.79; 95% confidence interval [CI]: 1.13–2.83; p = .012), dyspnea (1.66; 1.16–2.39; p = .004), SatO2 < 94% (1.73; 1.27–2.37; p = .001), temperature ≥ 37.8°C (1.62; 1.11–2.38; p = .013); qSOFA index ≥ 2 (1.62; 1.11–2.38; p = .013), bilateral infiltrates (1.98; 1.24–2.98; p < .001), and high C-reactive protein (1.005; 1.003–1.007; p < .001). In-hospital mortality was initially higher among LTCF residents (43.3% vs 39.7%), but lower after adjusting for sex, age, functional dependence, and comorbidities (aOR: 0.74, 95%CI: 0.62–0.87; p < .001). Conclusion Basal functional status and COVID-19 severity are risk factors of mortality in LTCF residents. The lower adjusted mortality rate in LTCF residents may be explained by earlier identification, treatment, and hospitalization for COVID-19.

中文翻译：

---

西班牙因 COVID-19 住院的长期护理机构居民的临床特征和死亡风险因素

摘要 背景COVID-19 严重影响了老年人和长期护理机构 (LTCF) 居民。我们的主要目的是描述 LTCF 居民和社区居住的因 COVID-19 住院的老年人之间的临床和流行病学变量、院内管理和结果之间的差异。第二个目标是确定住院 LTCF 居民因 COVID-19 死亡的危险因素。 方法这是对 160 家西班牙医院收治的年龄≥75 岁、确诊为 COVID-19 的住院患者进行的一项回顾性队列的横断面分析。通过比较和逻辑回归分析评估组间差异以及与 LTCF 居民死亡率相关的因素。 结果在 6 189 名≥75 岁患者中，1 185 名 (19.1%) 为 LTCF 居民，4 548 名 (73.5%) 为社区居民。LTCF 居民年龄较大（中位数：87.4 岁 vs 82.1 岁），大多数为女性（61.6% vs 43.2%），有更严重的功能依赖（47.0% vs 7.8%），更多合并症（查尔森合并症指数：6 vs 5），患有痴呆症与社区居住患者相比，出现频率更高（59.1% 对比 14.4%），并且症状持续时间更短（中位：3 对比 6 天）（全部，p < .001）。LTCF 居民的死亡风险因素包括严重的功能依赖性（调整后比值比 [aOR]：1.79；95% 置信区间 [CI]：1.13–2.83；p = .012）、呼吸困难（1.66；1.16–2.39；p = .004） ), SatO2 < 94%（1.73；1.27–2.37；p = .001），温度 ≥ 37.8°C（1.62；1.11–2.38；p = .013）；qSOFA 指数 ≥ 2 (1.62; 1.11–2.38; p = .013)，双侧浸润 (1.98; 1.24–2.98; p < .001)，以及高 C 反应蛋白 (1.005; 1.003–1.007; p < . 001）。LTCF 居民的院内死亡率最初较高（43.3% vs 39.7%），但在调整性别、年龄、功能依赖性和合并症后较低（aOR：0.74，95%CI：0.62–0.87；p < .001 ）。 结论基础功能状态和 COVID-19 严重程度是 LTCF 居民死亡的危险因素。LTCF 居民调整后死亡率较低的原因可能是较早发现、治疗和住院 COVID-19。