Residents of LTCFs in Midwest, South Face Higher Respiratory Infection Risk

Patients in long-term care facilities face a higher risk of influenza and pneumonia depending on which region of the country they live in, according to a new study.

The surprising results come from a data set of more than 7 million Medicare recipients who were residents of long-term care facilities (LTCFs) between 2013 and 2015. A team of investigators, most of whom were from Brown University, studied Medicare coding data along with location data for the patients’ residential facilities to create a map of pneumonia and influenza (P&I) cases in the selected years.

What they found was that patients living in facilities in the Midwest and southern United States had the highest risk of these 2 respiratory infections. Residents in the eastern and western United States had comparatively lower rates of hospitalizations. Clusters of counties with higher infection prevalence were found, though these clusters were particularly pronounced among long-term residents of the facilities.

The findings were published last month in Clinical Infectious Diseases.

In examining the geographic gaps, corresponding author Elliott Bosco, PharmD, of the Brown University School of Public Health, and colleagues wrote that differences in county-level or company-level quality of care might play a role.

“Counties with the highest and lowest rates might be particularly influenced by geographically-varying characteristics such as hospital proximity or similar policies across chain-affiliated LTCFs,” they wrote.

Vaccination rates among residents might also play a role, they said.

“Additionally, state departments of health may influence vaccination rates by providing vaccines directly to LTCFs, reducing supply disruptions,” they added.

Bosco and colleagues added that hospitals in some areas—but not others—might have existing relationships with LTCFs designed to reduce infections or hospitalizations.

The data are important because respiratory infections are a major health concern for older populations.

The authors note that in 2015 and 2016, nearly half of hospitalizations for influenza were for people 65 years old and older, as were 64% of deaths related to the flu and pneumonia. They also write that the 1.3 million LTCF residents who can be considered “frail” face a particularly high risk of hospitalization for respiratory infections.

Bosco and colleagues say they believe data like those in their report are essential to curbing the problem.

“Such information is highly relevant to local public health leaders and clinicians responsible for making decisions about resource allocation, treatment efforts, and infection control interventions to improve health outcomes for the vulnerable LTCF population,” they write.

Last year, Bosco and colleagues published a study which found that the characteristics of specific LTCFs, such as the numbers of physician assistants and nurse practitioners on staff, played a role in the risk of patients contracting a respiratory infection.

Still, further study will be necessary at both the national and local level. For instance, the authors note that their data might not capture more minor cases of influenza and the flu. They also did not factor in seasonal variation or the impact of local outbreaks. Those data might be necessary for local officials to drill down to specific action steps.