• Andrew P Costa, Derek R Manis, Aaron Jones, Nathan M Stall, Kevin A Brown, Veronique Boscart, Adriane Castellino, George A Heckman, Michael P Hillmer, Chloe Ma, Paul Pham, Saad Rais, Samir K Sinha, and Jeffrey W Poss.
• Department of Health Research Methods, Evidence, and Impact (Costa, Manis, Jones, Poss), Department of Medicine (Costa), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont.; Schlegel Research Institute for Aging (Costa, Boscart, Heckman), Waterloo, Waterloo, Ont.; Institute for Clinical Evaluative Sciences (IC/ES) (Costa, Jones, Stall), Toronto, Ont.; Centre for Health Economics and Policy Analyses (Costa, Manis), St. Joseph's Health System, Hamilton, Ont.; Division of General Internal Medicine and Geriatric Medicine (Stall, Sinha), Sinai Health and University Health Network; Department of Medicine (Stall, Sinha), University of Toronto; Institute of Health Policy, Management and Evaluation (Stall, Hillmer, Sinha), University of Toronto; Women's College Research Institute, Women's College Hospital (Stall); National Institute on Ageing, Ryerson University (Stall, Sinha); Infection Prevention and Control (Brown), Public Health Ontario; Dalla Lana School of Public Health (Brown), University of Toronto, Toronto, Ont.; Conestoga College Institute of Technology and Advanced Learning (Boscart), Kitchener, Ont.; Retirement Homes Regulatory Authority (RHRA) (Castellino, Ma, Pham), Toronto, Ont.; School of Public Health and Health Systems (Heckman, Poss), University of Waterloo, Waterloo, Ont.; Capacity Planning and Analytics (Hillmer, Rais), Ontario Ministry of Health, Toronto, Ont. acosta@mcmaster.ca.
• CMAJ. 2021 May 10; 193 (19): E672-E680.

BackgroundThe epidemiology of SARS-CoV-2 infection in retirement homes (also known as assisted living facilities) is largely unknown. We examined the association between home-and community-level characteristics and the risk of outbreaks of SARS-CoV-2 infection in retirement homes since the beginning of the first wave of the COVID-19 pandemic.MethodsWe conducted a population-based, retrospective cohort study of licensed retirement homes in Ontario, Canada, from Mar. 1 to Dec. 18, 2020. Our primary outcome was an outbreak of SARS-CoV-2 infection (≥ 1 resident or staff case confirmed by validated nucleic acid amplification assay). We used time-dependent proportional hazards methods to model the associations between retirement home- and community-level characteristics and outbreaks of SARS-CoV-2 infection.ResultsOur cohort included all 770 licensed retirement homes in Ontario, which housed 56 491 residents. There were 273 (35.5%) retirement homes with 1 or more outbreaks of SARS-CoV-2 infection, involving 1944 (3.5%) residents and 1101 staff (3.0%). Cases of SARS-CoV-2 infection were distributed unevenly across retirement homes, with 2487 (81.7%) resident and staff cases occurring in 77 (10%) homes. The adjusted hazard of an outbreak of SARS-CoV-2 infection in a retirement home was positively associated with homes that had a large resident capacity, were co-located with a long-term care facility, were part of larger chains, offered many services onsite, saw increases in regional incidence of SARS-CoV-2 infection, and were located in a region with a higher community-level ethnic concentration.InterpretationReadily identifiable characteristics of retirement homes are independently associated with outbreaks of SARS-CoV-2 infection and can support risk identification and priority for vaccination.© 2021 CMA Joule Inc. or its licensors.

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