Table 2.

Risk Factors for Mortality in Nursing Home Residents

Risk Factor	References	Summary
Individual characteristics
Age	82,84,87	•Sweden, N = 3731 residents: 30-day mortality greater aged >80 y (adjusted OR 2.99) and >90 y (adjusted OR 3.28) vs those aged <70 y82 •Spain, N = 2140 residents; N = 9121 from general population: Greater risk of mortality in nursing home residents aged >80 y84 •France, N = 480 infected residents: greater mortality risk in residents aged >85 y (OR 2.36)87
Male sex	82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93	•Sweden, N = 3731 residents: Male sex associated with greater 30-day mortality (OR 2.60)82 •USA, N = 5256 residents: women had a lower 30-day mortality than men (HR 0.69)93
Dementia and neuropsychological conditions	88,90,93	•Spain, N = 842 residents: Moderate/severe dementia associated with greater mortality (adjusted OR: 2.64)88 •Netherlands, N = 1294 residents: Dementia associated with an increased 30-d mortality (HR: 1.3)90 •USA, N = 5256 residents: Severe cognitive impairment associated with greater risk of 30-d mortality (OR: 2.79)93
Diabetes	82,93	•USA, N = 5256 residents: Diabetes associated with greater risk of 30-day mortality (OR: 1.21)93 •Sweden, N = 3731 residents: Diabetes associated with greater likelihood of COVID-19 mortality82
Chronic kidney disease	84,91,92	•USA, N = 6798 residents: Poorer kidney function associated with greater likelihood of mortality91 •Sweden, N = 3731 residents: Chronic kidney disease associated with greater mortality82 •Canada, N = 5029 residents: Lower eGFR associated with greater mortality92
Cardiovascular disease	84,92	•Spain, N = 3567 residents: Cardiovascular Disease associated with mortality in 3567 nursing home residents (OR: 1.49)84 •Canada, N = 5029: Cardiovascular comorbidities and heart failure associated with increased mortality92
Greater dependency and poorer physical function	88,92,93	•Spain, N = 842 residents: Greater Barthel Index associated with greater likelihood of mortality (adjusted OR: 5.03)88 •Canada, N = 5029 residents: Poorer function on activities of daily living and pressure ulcer risk scores linked with greater mortality92 •USA, N = 5256 residents: Functional dependence associated with greater mortality in 1185 residents admitted to hospital93
COVID-19 illness characteristics
Symptomatic disease (pyrexia and dyspnea)	89,92, 93, 94, 95	•Italy, N = 382 residents: Symptomatic illness associated with greater mortality (HR: 3.99)89 •Spain, N = 1185 residents: Fever (OR:1.67) and dyspnea (OR: 1.66) associated with mortality in those admitted to hospital94
Bilateral pulmonary infiltrates	93,94	•Spain, N = 1185 residents: bilateral infiltrates on chest radiograph associated with greater mortality (OR: 1.98)93
Hypoxia	94	•Spain, N = 1185 residents: Hypoxia associated with 30-d inpatient mortality (OR: 2.05)94
Routine laboratory abnormalities Higher C-reactive protein and interleukin-6 (IL-6) Lymphopenia, hypernatremia, lower albumin	92, 93, 94, 95	•Canada, N = 5029 residents: Lower hemoglobin, lymphocyte count, and serum albumin associated with higher mortality92 •Spain, N = 1185 residents: High C-reactive protein (CRP) associated with mortality94 •Italy, N = 50 residents: High IL-6 associated with mortality95
Facility-level characteristics
Racial and ethnic composition of nursing homes	96, 97, 98	•USA, N = 13,123 facilities: Racial and ethnic composition linked to increased death rates in high-minority communities96 •USA, N = 51,606 COVID-19 deaths: Mean number of deaths in nursing homes with the lowest proportion of White residents significantly greater than those with the greatest proportion of White residents97
Area-level socioeconomic deprivation	99	•England, N = 149 facilities: COVID-19 deaths more common in the most deprived quartiles of Income Deprivation Affected Older People Index (IDAOPI) (IRR: 1.23)99
Larger nursing homes and larger providers	75,100	•USA, N = 1162 facilities: Greater number of total beds and a greater occupancy rate associated with greater likelihood of experiencing 6 or more COVID-19 deaths100 •England, N = 29,542 deaths: Greater COVID-1– attributable death with large provider (OR 1.2) and larger vs smaller facilities (OR 13.3)75
For-profit status	100	•USA, N = 1162 facilities: For-profit status independently associated with greater likelihood of experiencing more than 6 COVID-19 deaths100
Nursing home quality	64,65	•USA, N = 1223 facilities: Significantly lower likelihood of death with a 5-star CMS rating64 •USA, N = 15,390 facilities: 30% higher deaths in nursing homes with 1-star CMS ratings65

eGFR, estimated glomerular filtration rate; HR, hazard ratio; IRR, incidence rate ratio; OR, odds ratio.