Association of Hospital- and Patient-Level Characteristics on SARS-CoV-2 Infection and COVID-19 Mortality among Patients in Korean Long-Term Care Hospitals: A Multilevel Analysis

The Coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected vulnerable populations in long-term care hospitals (LTCHs). This study examined the interplay between patient and hospital factors in relation to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and COVID-19 mortality in Korean LTCHs. This retrospective cohort study included 262,221 patients (aged ≥60) who were hospitalized for ≥30 days in 2021. Multilevel logistic regression models were used to assess the association of hospital and patient factors with SARS-CoV-2 infection and COVID-19 mortality. At the hospital level, more doctors were associated with a decreased risk of SARS-CoV-2 infection (odds ratio [OR] = 0.84, 95% confidence interval [CI]: 0.73-0.98) and COVID-19 mortality (OR = 0.85, 95% CI: 0.78-0.93), whereas nurses/aides were associated with an increased risk of SARS-CoV-2 infection (OR = 1.02, 95% CI: 1.00-1.03) and COVID-19 mortality (OR = 1.01, 95% CI: 1.00-1.02). Among patient-level factors, female sex (infection OR = 0.89, 95% CI: 0.83-0.96; mortality OR = 0.65, 95% CI: 0.55-0.77) was associated with decreased risks of both infection and mortality. These findings highlight the importance of staffing and infection control measures to mitigate COVID-19 risk in LTCH settings.