Relationship between nursing home COVID-19 outbreaks and staff neighborhood characteristics

  1. Karen Shen

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Abstract

The COVID-19 pandemic has been particularly deadly for residents of nursing homes and other long-term care facilities. This paper analyzes COVID-19 deaths at nursing homes during the first wave of the pandemic in the United States during the spring and early summer 2020. By combining data on facility-level COVID-19 deaths during this period with data on the neighborhoods where nursing home staff reside for a sample of eighteen states, this paper finds that staff neighborhood characteristics were a large and significant predictor of COVID-19 nursing home deaths. Even after controlling for the county where a facility is located, one standard deviation increases in average staff neighborhood (Census tract) population density, public transportation use, and non-white share were associated with 1.3 (p < .001), 1.4 (p < .001), and 0.9 (p < .001) additional deaths per 100 beds, respectively. These effects are larger than all facility management or quality variables, and larger than the effect of the nursing home’s own neighborhood characteristics. These results suggest COVID-19 outbreaks in staff communities can have large consequences for the facilities where they work, even in highly-rated facilities, and that disparities in nursing home outbreaks may be related to differences in the types of neighborhoods nursing home staff live in.

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  1. Version published to 10.1371/journal.pone.0267377
  2. ScreenIT

    SciScore for 10.1101/2020.09.10.20192203: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: Thank you for sharing your data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    This study has a few limitations. First, it is important to note that the analysis in this study is correlational and there may therefore be omitted variables that are driving the results. For example, S5 Table shows that the coefficients on staff neighborhood characteristics are reduced if the distance of the nursing home to the central business district of the nearest metropolitan area is included, though they remain relatively large and statistically significant. This could either mean that (1) staff neighborhood characteristics are a true risk factor for facility outbreaks, and nursing homes that are more centrally located are simply likelier to draw staff from more exposed neighborhoods, or (2) centrality affects facility outbreaks through other mechanisms besides staff neighborhoods. However, in this case, the fact that staff neighborhood characteristics continue to be significant after controlling for centrality suggest that the former may be more important, and also offer a lower bound for these effects. A second limitation is that because the analysis is within counties, it cannot offer much insight into the effects of different county- or state-level policies in the COVID-19 response, though these are likely to have been important in determining infection rates and deaths. Third, although Table 2 offers suggestive evidence that the relationship between staff neighborhood characteristics and can be explained by higher infection rates in these neighborhoods, it is lim...

    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 rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2020.09.10.20192203v2 on medRxiv
  4. Version published to 10.1101/2020.09.10.20192203v1 on medRxiv