TABLE. Pooled mean SARS-CoV-2 incidence and COVID-19–associated death rates* per 10,000 patient-weeks among maintenance dialysis patients during each COVID-19 wave,† by region, urbanicity, social vulnerability index, facility size, primary vaccination status, and monovalent booster dose receipt status — National Healthcare Safety Network, United States, June 30, 2021–September 27, 2022.
| Characteristic | SARS-CoV-2 incidence, by wave (95% CI) |
COVID-19–associated death rates, by wave (95% CI) |
||||||
|---|---|---|---|---|---|---|---|---|
| Overall | Delta | First Omicron | Second Omicron | Overall | Delta | First Omicron | Second Omicron | |
|
Overall§
|
30.47
(29.02–31.97)
|
20.13
(18.99–21.36)
|
46.45
(44.64–48.30)
|
25.05
(23.74–26.44)
|
1.74
(1.44–2.12)
|
1.96
(1.62–2.34)
|
2.66
(2.26–3.11)
|
0.59
(0.43–0.81)
|
|
Region¶
| ||||||||
| Midwest |
27.64
(27.26–28.02)
|
16.92
(16.29–17.56) |
52.48
(51.47–53.51) |
23.55
(22.95–24.16) |
1.65
(1.56–1.75)
|
1.43
(1.25–1.62) |
3.52
(3.26–3.79) |
0.54
(0.45–0.64) |
| Mountain |
28.12
(27.45–28.81)
|
24.35
(23.03–25.72) |
51.81
(50.04–53.62) |
22.02
(21.00–23.08) |
1.89
(1.72–2.07)
|
1.91
(1.56–2.31) |
4.12
(3.64–4.65) |
0.66
(0.50–0.86) |
| Northeast |
28.26
(27.83–28.70)
|
9.90
(9.37–10.46) |
52.72
(51.57–53.89) |
28.87
(28.11–29.64) |
1.63
(1.53–1.74)
|
1.00
(0.83–1.18) |
2.90
(2.64–3.18) |
0.87
(0.75–1.01) |
| Pacific |
24.71
(24.34–25.09)
|
13.31
(12.74–13.91) |
41.54
(40.61–42.49) |
29.28
(28.57–30.00) |
1.01
(0.94–1.09)
|
1.19
(1.02–1.37) |
1.83
(1.65–2.04) |
0.44
(0.36–0.53) |
| South |
26.11
(25.87–26.35)
|
26.60
(26.09–27.12) |
43.39
(42.79–43.99) |
21.63
(21.25–22.01) |
1.68
(1.62–1.74)
|
2.74
(2.58–2.91) |
2.48
(2.34–2.63) |
0.54
(0.48–0.60) |
| Noncontiguous |
43.56
(41.55–45.64)
|
40.00
(36.01–44.31) |
52.40
(48.18–56.89) |
58.45
(54.48–62.63) |
1.57
(1.22–2.00)
|
3.36
(2.31–4.74) |
1.60
(0.96–2.51) |
0.96
(0.54–1.60) |
|
Urbanicity**,††
| ||||||||
| Large core metro |
28.33
(27.26–28.02)
|
16.16
(16.29–17.56) |
45.03
(51.47–53.51) |
23.02
(22.95–24.16) |
1.26
(1.56–1.75)
|
1.37
(1.25–1.62) |
2.19
(3.26–3.79) |
0.45
(0.45–0.64) |
| Large fringe metro |
28.14
(27.45–28.81)
|
16.33
(23.03–25.72) |
43.78
(50.04–53.62) |
23.53
(21.00–23.08) |
1.41
(1.72–2.07)
|
1.49
(1.56–2.31) |
2.49
(3.64–4.65) |
0.51
(0.50–0.86) |
| Medium metro |
33.16
(27.83–28.70)
|
24.49
(9.37–10.46) |
48.40
(51.57–53.89) |
26.75
(28.11–29.64) |
1.84
(1.53–1.74)
|
2.36
(0.83–1.18) |
2.88
(2.64–3.18) |
0.67
(0.75–1.01) |
| Small metro |
32.78
(24.34–25.09)
|
25.43
(12.74–13.91) |
48.64
(40.61–42.49) |
25.14
(28.57–30.00) |
2.15
(0.94–1.09)
|
2.92
(1.02–1.37) |
3.40
(1.65–2.04) |
0.66
(0.36–0.53) |
| Rural |
35.70
(25.87–26.35)
|
27.66
(26.09–27.12) |
52.62
(42.79–43.99) |
27.73
(21.25–22.01) |
2.62
(1.62–1.74)
|
3.75
(2.58–2.91) |
3.94
(2.34–2.63) |
0.85
(0.48–0.60) |
| Noncore |
34.59
(41.55–45.64)
|
27.09
(36.01–44.31) |
49.66
(48.18–56.89) |
27.69
(54.48–62.63) |
2.39
(1.22–2.00)
|
3.43
(2.31–4.74) |
3.48
(0.96–2.51) |
0.83
(0.54–1.60) |
|
SVI§§
| ||||||||
| Low |
30.92
(30.57–31.27)
|
18.21
(17.69–18.74) |
46.93
(46.17–47.69) |
26.55
(26.04–27.06) |
1.64
(1.56–1.72)
|
1.75
(1.59–1.92) |
2.83
(2.65–3.03) |
0.61
(0.54–0.70) |
| Medium |
30.99
(30.66–31.32)
|
21.02
(20.51–21.55) |
47.37
(46.66–48.10) |
24.58
(24.12–25.05) |
1.77
(1.69–1.85)
|
2.06
(1.90–2.23) |
2.93
(2.76–3.12) |
0.65
(0.58–0.72) |
| High |
30.06
(29.76–30.37)
|
21.23
(20.73–21.73) |
45.74
(45.07–46.41) |
23.43
(23.01–23.86) |
1.59
(1.53–1.67)
|
2.25
(2.09–2.41) |
2.44
(2.29–2.59) |
0.50
(0.44–0.56) |
|
Facility size¶¶
| ||||||||
| Small |
32.50
(32.13–32.88)
|
23.28
(22.68–23.89) |
48.88
(48.08–49.69) |
25.63
(25.12–26.15) |
1.66
(1.58–1.75)
|
1.91
(1.74–2.09) |
2.81
(2.62–3.01) |
0.60
(0.52–0.68) |
| Medium |
30.30
(29.95–30.67)
|
20.53
(19.97–21.11) |
46.21
(45.43–46.99) |
24.16
(23.66–24.66) |
1.66
(1.58–1.75)
|
2.02
(1.84–2.20) |
2.78
(2.59–2.97) |
0.55
(0.48–0.63) |
| Large |
30.28
(29.99–30.57)
|
18.38
(17.95–18.82) |
46.09
(45.46–46.72) |
25.57
(25.15–25.99) |
1.65
(1.58–1.72)
|
1.93
(1.79–2.07) |
2.68
(2.53–2.83) |
0.63
(0.57–0.70) |
|
Primary vaccination status***
| ||||||||
| Full primary series |
27.24
(25.65–28.90)
|
13.10
(12.00–14.28) |
40.89
(38.91–42.91) |
25.10
(23.58–26.71) |
—
|
— |
— |
— |
| Not vaccinated |
39.64
(36.60–42.91)
|
36.12
(33.39–39.05) |
61.86
(57.90–66.08) |
23.91
(21.50–26.60) |
—
|
— |
— |
— |
|
Monovalent booster dose status†††
| ||||||||
| Full primary series and ≥1 booster dose |
30.62
(28.24–33.21)
|
— |
38.32
(35.16–41.62) |
26.70
(24.62–28.86) |
—
|
— |
— |
— |
| No booster dose | 33.69 (31.27–36.24) | — | 42.21 (39.76–44.80) | 22.93 (20.75–25.30) | — | — | — | — |
Abbreviations: NHSN = National Healthcare Safety Network; SVI = social vulnerability index.
* Cases and deaths per 10,000 patient-weeks. COVID-19–related deaths were defined as those among patients who died before fully recovering from SARS-CoV-2 infection; NHSN receives aggregate facility-level data; therefore, death rates could not be calculated by vaccination status.
† Delta (June 30–October 26, 2021), first Omicron (October 27, 2021–March 22, 2022), and second Omicron (March 23–September 27, 2022).
§ Pooled rates within each category might differ from overall rates because of smaller sized subcategories.
¶ South: Alabama, Arkansas, Delaware, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, West Virginia, and District of Columbia; Midwest: Ilinois, Indiana, Iowa, Kansas, Michigan, Minesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; Mountain: Arizona, Colorado, Idaho, Montana, New Mexico, Nevada, Utah, and Wyoming; Pacific: California, Oregon, and Washington; Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont; Noncontiguous: Alaska and Hawaii.
** Washington, DC, Puerto Rico, and U.S. Virgin Islands were not included in urbanicity subanalysis.
†† https://www.ers.usda.gov/data-products/rural-urban-continuum-codes
§§ https://www.atsdr.cdc.gov/placeandhealth/svi/index.html
¶¶ Small, medium, and large facilities are defined as having 0–16, 17–22, and ≥23 dialysis stations, respectively.
*** Primary vaccination data were available during all three waves (June 30, 2021–September 27, 2022).
††† Monovalent booster dose vaccination data were only available during first and second Omicron waves (October 27, 2021–September 27, 2022).