State social distancing restrictions and nursing home outcomes

  1. Yue Li
  2. Zijing Cheng
  3. Xueya Cai
  4. Yunjiao Mao
  5. Helena Temkin-Greener

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Abstract

The COVID-19 poses a disproportionate threat to nursing home residents. Although recent studies suggested the effectiveness of state social distancing measures in the United States on curbing COVID-19 morbidity and mortality among the general population, there is a lack of evidence as to how these state orders may have affected nursing home patients or what potential negative health consequences they may have had. In this longitudinal study, we evaluated changes in state strength of social distancing restrictions from June to August of 2020, and their associations with the weekly numbers of new COVID-19 cases, new COVID-19 deaths, and new non-COVID-19 deaths in nursing homes of the US. We found that stronger state social distancing measures were associated with improved COVID-19 outcomes (case and death rates), reduced across-facility disparities in COVID-19 outcomes, and somewhat increased non-COVID-19 death rate, although the estimates for non-COVID-19 deaths were sensitive to alternative model specifications.

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  1. Version published to 10.1038/s41598-022-05011-6
  2. ScreenIT

    SciScore for 10.1101/2021.02.08.21251382: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    NIH rigor criteria are not applicable to paper type.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    38 We then linked this longitudinal database to several other data files including: (1) the CMS Nursing Home Compare (NHC) data files (updated in August of 2020) to obtain important covariates of nursing home organizational, staffing, and quality of care measures;39 (2) the LTCFocus file created by the Brown University for additional nursing home characteristics; (3) the Area Healthcare Resource File for key county covariates; and (4) the numbers of lab-confirmed COVID-19 cases and deaths for all counties and states obtained from the national database published by the New York Times (https://github.com/nytimes/covid-19-data).
    Area Healthcare
    suggested: None

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    This study has several limitations. First, we were only able to track state social-distancing measures and nursing home COVID-19 and non-COVID-19 outcomes starting in June due to the lack of national data in early period of the pandemic. Second, although we demonstrated that in aggregate, stronger state social distancing measures had both positive and negative health consequences on nursing home residents, we cannot determine the effect of individual state policies or orders. Finally, our ability to adjust for nursing home, county, and state covariates may be somewhat limited in multivariable analyses. Therefore, the estimated associations may be partially mediated by unmeasured factors that affect COVID-19 outcomes and non-COVID-19 deaths among nursing home residents. In conclusion, we found that stronger state social distancing measures were associated with improved COVID-19 outcomes (case and death rates), reduced across-facility disparities in COVID-19 outcomes, but more non-COVID-19 deaths among nursing home residents. More restrictive mitigation rules may lead to both health benefits and unintended health consequences.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from scite Reference Check: We found no unreliable references.

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  3. Version published to 10.1101/2021.02.08.21251382v1 on medRxiv