Hospital admission and mortality rates for non-Covid diseases among residents of the long-term care facilities before and during the pandemic: a cohort study in two Italian regions

Sara Mazzilli; Giuditta Scardina; Francesca Collini; Silvia Forni; Giulio Gianolio; Lucia Bisceglia; Pier Luigi Lopalco; Antonio Chieti; Graziano Onder; Nicola Vanacore; Guglielmo Bonaccorsi; Fabrizio Gemmi; Lara Tavoschi

doi:10.1007/s10389-023-01925-1

Hospital admission and mortality rates for non-Covid diseases among residents of the long-term care facilities before and during the pandemic: a cohort study in two Italian regions

Z Gesundh Wiss. 2023 May 16:1-13. doi: 10.1007/s10389-023-01925-1. Online ahead of print.

Authors

Affiliations

¹ Scuola Normale Superiore, Pisa, Italy.
² Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
³ Quality and Equity Unit, Regional Health Agency of Tuscany, Florence, Italy.
⁴ Strategic Regional Health and Social Agency of Puglia (AReSS Puglia), Bari, Italy.
⁵ Department of Biological and Environmental Sciences and Technology, University of Salento, Lecce, Italy.
⁶ Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, National Institute of Health, Rome, Italy.
⁷ National Centre for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy.
⁸ Department of Health Science, University of Florence, Florence, Italy.

Abstract

Aim: Long-term-care facility residents are a vulnerable population who experienced reduced healthcare access during the pandemic. This study aimed to assess the indirect impact of the COVID-19 pandemic, in terms of hospitalisation and mortality rates, among this population in two Italian Regions, Tuscany and Apulia, during 2020 in comparison with the pre-pandemic period.

Subject and methods: We conducted a retrospective cohort study on people residing in long-term-care facilities from 1 January 2018 to 31 December 2020 (baseline period: 1 January 2018-8 March 2020; pandemic period: and 9 March-31 December 2020). Hospitalisation rates were stratified by sex and major disease groups. Standardised weekly rates were estimated with a Poisson regression model. Only for Tuscany, mortality risk at 30 days after hospitalisation was calculated with the Kaplan-Meier estimator. Mortality risk ratios were calculated using Cox proportional regression models.

Results: Nineteen thousand two hundred and fifty individuals spent at least 7 days in a long-term-care facility during the study period. The overall mean non-Covid hospital admission rate per 100 000 residents/week was 144.1 and 116.2 during the baseline and pandemic periods, with a decrease to 99.7 and 77.3 during the first (March-May) and second lockdown (November-December). Hospitalisation rates decreased for all major disease groups. Thirty-day mortality risk ratios for non-Covid conditions increased during the pandemic period (1.2, 1.1 to 1.4) compared with baseline.

Conclusion: The pandemic resulted in worse non-COVID-related health outcomes for long-term-care facilities' residents. There is a need to prioritise these facilities in national pandemic preparedness plans and to ensure their full integration in national surveillance systems.

Supplementary information: The online version contains supplementary material available at 10.1007/s10389-023-01925-1.

Keywords: Covid-19 pandemic; Hospital admission; Long-term care facilities; Mortality risk.