United states nursing home COVID-19 mortality 2020-2022

COVID-19 mortality has been concentrated in the nursing home (NH) population, due to the synergy of multilevel risk factors attributable to facilities, neighborhoods, and individuals. In this cohort study, we estimated COVID-19 mortality in this population, explore geographic pockets of high mortality, and assess factors associated with increased mortality during 2020-2022. The NH population average COVID-19 mortality rate was 113.4, 36.4, and 15.3 per 1000 person-years in 2020, 2021, and 2022, respectively. Mortality was lower among homes with better care quality, hospital access, higher staffing hours per resident, greater staff vaccine coverage, and in higher-income neighborhoods. However, the association of mortality with facility-level racial composition, neighborhood income, hospital quality of care varied between pre- and post-vaccine periods. Mitigation strategies may incorporate care improvement, adequate staffing, adherence to infection prevention and control procedures, provision of onsite medicalization and telemedicine, promotion of vaccination among staff and residents, and sustained substantial funding for nursing homes in general and investments in lower income neighborhoods, while monitoring temporal variations in rates of infection and mortality in different geographic, racial, and socioeconomic domains.