Predictors of COVID-19 infection and hospitalization in group homes for individuals with intellectual and/or developmental disabilities

doi:10.1016/j.dhjo.2024.101645

. 2024 Oct;17(4):101645.

doi: 10.1016/j.dhjo.2024.101645. Epub 2024 Jun 5.

Predictors of COVID-19 infection and hospitalization in group homes for individuals with intellectual and/or developmental disabilities

Julie H Levison¹, Vicki Fung², Anna Wilson³, David Cheng⁴, Karen Donelan⁵, Nicolas M Oreskovic⁶, Ronita Samuels³, Paula Silverman⁷, Joey Batson⁷, Ahmed Fathi⁷, Stefanie Gamse⁷, Sibyl Holland⁷, Jessica E Becker⁸, Kenneth A Freedberg⁹, Lisa I Iezzoni², Amy Donohue¹⁰, Mark Viron¹⁰, Carley Lubarsky¹¹, Terina Keller¹¹, Jean-Louise Reichman¹², Bettina Bastien¹³, Elizabeth Ryan⁷, Alexander C Tsai², John Hsu¹⁴, Cindy Chau³, David Krane³, Hao D Trieu³, Jessica Wolfe⁷, Kim Shellenberger⁷, Elizabeth Cella⁷, Bruce Bird⁷, Stephen Bartels⁹, Brian G Skotko⁶

Affiliations

¹ Massachusetts General Hospital, Mongan Institute, 100 Cambridge St, Suite 1600, Boston, MA, 02114, USA; Massachusetts General Hospital, Department of Medicine, 55 Fruit St, Gray 7-730, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA. Electronic address: jlevison@mgb.org.
² Massachusetts General Hospital, Mongan Institute, 100 Cambridge St, Suite 1600, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
³ Massachusetts General Hospital, Mongan Institute, 100 Cambridge St, Suite 1600, Boston, MA, 02114, USA.
⁴ Massachusetts General Hospital, Mongan Institute, 100 Cambridge St, Suite 1600, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA; Massachusetts General Hospital, Biostatistics Center, 50 Staniford Street, Suite 560, Boston, MA, 02114, USA.
⁵ Massachusetts General Hospital, Mongan Institute, 100 Cambridge St, Suite 1600, Boston, MA, 02114, USA; Heller School for Social Policy and Management, Brandeis University, 415 South St, Waltham, MA, 02453, USA.
⁶ Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA; Massachusetts General Hospital, Department of Pediatrics, Division of Medical Genetics and Metabolism, Down Syndrome Program, 125 Nashua Street, Suite 821, Boston, MA, 02114, USA.
⁷ Vinfen Corporation, 950 Cambridge Street, Cambridge, MA, 02141, USA.
⁸ NYU Grossman School of Medicine and NYU Langone Health, Department of Child and Adolescent Psychiatry, 550 First Avenue, New York, NY, 10016, USA.
⁹ Massachusetts General Hospital, Mongan Institute, 100 Cambridge St, Suite 1600, Boston, MA, 02114, USA; Massachusetts General Hospital, Department of Medicine, 55 Fruit St, Gray 7-730, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
¹⁰ Advocates, Inc. 1881 Worcester Rd, Framingham, MA, 01701, USA.
¹¹ Bay Cove Human Services, 66 Canal Street, Boston, MA, 02114, USA.
¹² North Suffolk Mental Health Association, 301 Broadway, Chelsea, MA, 02150, USA.
¹³ Riverside Community Care, 270 Bridge Street, Suite 301, Dedham, MA, 02026, USA.
¹⁴ Massachusetts General Hospital, Mongan Institute, 100 Cambridge St, Suite 1600, Boston, MA, 02114, USA; Harvard Medical School, Department of Medicine, 25 Shattuck Street, Boston, MA, 02115, USA; Harvard Medical School, Department of Health Care Policy, 180 Longwood Avenue, Boston, MA, 02115, USA.

PMID: 38879412
PMCID: PMC11454325 (available on 2025-10-01)
DOI: 10.1016/j.dhjo.2024.101645

Predictors of COVID-19 infection and hospitalization in group homes for individuals with intellectual and/or developmental disabilities

Julie H Levison et al. Disabil Health J. 2024 Oct.

. 2024 Oct;17(4):101645.

doi: 10.1016/j.dhjo.2024.101645. Epub 2024 Jun 5.

Authors

Affiliations

¹ Massachusetts General Hospital, Mongan Institute, 100 Cambridge St, Suite 1600, Boston, MA, 02114, USA; Massachusetts General Hospital, Department of Medicine, 55 Fruit St, Gray 7-730, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA. Electronic address: jlevison@mgb.org.
² Massachusetts General Hospital, Mongan Institute, 100 Cambridge St, Suite 1600, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
³ Massachusetts General Hospital, Mongan Institute, 100 Cambridge St, Suite 1600, Boston, MA, 02114, USA.
⁴ Massachusetts General Hospital, Mongan Institute, 100 Cambridge St, Suite 1600, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA; Massachusetts General Hospital, Biostatistics Center, 50 Staniford Street, Suite 560, Boston, MA, 02114, USA.
⁵ Massachusetts General Hospital, Mongan Institute, 100 Cambridge St, Suite 1600, Boston, MA, 02114, USA; Heller School for Social Policy and Management, Brandeis University, 415 South St, Waltham, MA, 02453, USA.
⁶ Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA; Massachusetts General Hospital, Department of Pediatrics, Division of Medical Genetics and Metabolism, Down Syndrome Program, 125 Nashua Street, Suite 821, Boston, MA, 02114, USA.
⁷ Vinfen Corporation, 950 Cambridge Street, Cambridge, MA, 02141, USA.
⁸ NYU Grossman School of Medicine and NYU Langone Health, Department of Child and Adolescent Psychiatry, 550 First Avenue, New York, NY, 10016, USA.
⁹ Massachusetts General Hospital, Mongan Institute, 100 Cambridge St, Suite 1600, Boston, MA, 02114, USA; Massachusetts General Hospital, Department of Medicine, 55 Fruit St, Gray 7-730, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
¹⁰ Advocates, Inc. 1881 Worcester Rd, Framingham, MA, 01701, USA.
¹¹ Bay Cove Human Services, 66 Canal Street, Boston, MA, 02114, USA.
¹² North Suffolk Mental Health Association, 301 Broadway, Chelsea, MA, 02150, USA.
¹³ Riverside Community Care, 270 Bridge Street, Suite 301, Dedham, MA, 02026, USA.
¹⁴ Massachusetts General Hospital, Mongan Institute, 100 Cambridge St, Suite 1600, Boston, MA, 02114, USA; Harvard Medical School, Department of Medicine, 25 Shattuck Street, Boston, MA, 02115, USA; Harvard Medical School, Department of Health Care Policy, 180 Longwood Avenue, Boston, MA, 02115, USA.

PMID: 38879412
PMCID: PMC11454325 (available on 2025-10-01)
DOI: 10.1016/j.dhjo.2024.101645

Abstract

Background: More than seven million people with intellectual and/or developmental disabilities (ID/DD) live in the US and may face an elevated risk for COVID-19.

Objective: To identify correlates of COVID-19 and related hospitalizations among people with ID/DD in group homes in Massachusetts.

Methods: We collected data during March 1, 2020-June 30, 2020 (wave 1) and July 1, 2020-March 31, 2021 (wave 2) from the Massachusetts Department of Public Health and six organizations administering 206 group homes for 1035 residents with ID/DD. The main outcomes were COVID-19 infections and related hospitalizations. We fit multilevel Cox proportional hazards models to estimate associations with observed predictors and assess contextual home- and organizational-level effects.

Results: Compared with Massachusetts residents, group home residents had a higher age-adjusted rate of COVID-19 in wave 1 (incidence rate ratio [IRR], 12.06; 95 % confidence interval [CI], 10.51-13.84) and wave 2 (IRR, 2.47; 95 % CI, 2.12-2.88) and a higher age-adjusted rate of COVID-19 hospitalizations in wave 1 (IRR, 17.64; 95 % CI, 12.59-24.70) and wave 2 (IRR, 4.95; 95 % CI, 3.23-7.60). COVID-19 infections and hospitalizations were more likely among residents aged 65+ and in group homes with 6+ resident beds and recent infection among staff and residents.

Conclusions: Aggressive efforts to decrease resident density, staff-to-resident ratios, and staff infections through efforts such as vaccination, in addition to ongoing access to personal protective equipment and COVID-19 testing, may reduce COVID-19 and related hospitalizations in people with ID/DD living in group homes.

Keywords: COVID-19; Congregate living settings; Disabilities; Group homes; SARS-CoV-2.

PubMed Disclaimer

Conflict of interest statement

Declaration of competing interest Dr. Levison is a medical advisor to eMED, LLC. Dr. Tsai receives a financial honorarium from Elsevier, Inc. for his work as Co-Editor in Chief of the Elsevier-owned journal SSM-Mental Health. Dr. Donelan is an unpaid board member of Bridges Associates Inc, a non-profit organization serving persons with intellectual and developmental disabilities. Dr. Becker is a current recipient of the American Academy of Child and Adolescent Psychiatry (AACAP) Junior Investigator Award supported by AACAP and Industry Sponsors (Sunovion Pharmaceuticals, Inc. and Supernus Pharmaceuticals, Inc.). Dr. Skotko occasionally consults on the topic of Down syndrome through Gerson Lehrman Group. He receives remuneration from Down syndrome non-profit organizations for speaking engagements and associated travel expenses. In the past two years, Dr. Skotko received annual royalties from Woodbine House, Inc., for the publication of his book, Fasten Your Seatbelt: A Crash Course on Down Syndrome for Brothers and Sisters. Within the past two years, he has received research funding from F. Hoffmann-La Roche, Inc., AC Immune, and LuMind Research Down Syndrome Foundation to conduct clinical trials for people with Down syndrome. Dr. Skotko is occasionally asked to serve as an expert witness for legal cases where Down syndrome is discussed. Dr. Skotko serves in a non-paid capacity on the Honorary Board of Directors for the Massachusetts Down Syndrome Congress and the Professional Advisory Committee for the National Center for Prenatal and Postnatal Down Syndrome Resources. Dr. Skotko has a sister with Down syndrome.

References

1. Alper J, Martinez RM, McHugh K, eds. Optimizing Care Systems for People with Intellectual and Developmental Disabilities: Proceedings of a Workshop. National Academies Press; 2022. 10.17226/26624. - DOI - PubMed
1. Larson SA, Lakin KC, Anderson L, Kwak N, Lee JH, Anderson D. Prevalence of mental retardation and developmental disabilities: estimates from the 1994/1995 national health interview survey disability supplements. Am J Ment Retard AJMR. 2001;106(3):231–252. - PubMed
1. Kinnear D, Morrison J, Allan L, Henderson A, Smiley E, Cooper SA. Prevalence of physical conditions and multimorbidity in a cohort of adults with intellectual disabilities with and without Down syndrome: cross-sectional study. BMJ Open. 2018;8(2), e018292. 10.1136/bmjopen-2017-018292. - DOI - PMC - PubMed
1. O’Leary L, Cooper SA, Hughes-McCormack L. Early death and causes of death of people with intellectual disabilities: a systematic review. J Appl Res Intellect Disabil JARID. 2018;31(3):325–342. 10.1111/jar.12417. - DOI - PubMed
1. Binkley CJ, Haugh GS, Kitchens DH, Wallace DL, Sessler DI. Oral microbial and respiratory status of persons with mental retardation/intellectual and developmental disability: an observational cohort study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108(5):722–731. 10.1016/j.tripleo.2009.06.027. - DOI - PMC - PubMed

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[1] Alper J, Martinez RM, McHugh K, eds. Optimizing Care Systems for People with Intellectual and Developmental Disabilities: Proceedings of a Workshop. National Academies Press; 2022. 10.17226/26624. - DOI - PubMed

[2] Alper J, Martinez RM, McHugh K, eds. Optimizing Care Systems for People with Intellectual and Developmental Disabilities: Proceedings of a Workshop. National Academies Press; 2022. 10.17226/26624. - DOI - PubMed

[3] Larson SA, Lakin KC, Anderson L, Kwak N, Lee JH, Anderson D. Prevalence of mental retardation and developmental disabilities: estimates from the 1994/1995 national health interview survey disability supplements. Am J Ment Retard AJMR. 2001;106(3):231–252. - PubMed

[4] Larson SA, Lakin KC, Anderson L, Kwak N, Lee JH, Anderson D. Prevalence of mental retardation and developmental disabilities: estimates from the 1994/1995 national health interview survey disability supplements. Am J Ment Retard AJMR. 2001;106(3):231–252. - PubMed

[5] Kinnear D, Morrison J, Allan L, Henderson A, Smiley E, Cooper SA. Prevalence of physical conditions and multimorbidity in a cohort of adults with intellectual disabilities with and without Down syndrome: cross-sectional study. BMJ Open. 2018;8(2), e018292. 10.1136/bmjopen-2017-018292. - DOI - PMC - PubMed

[6] Kinnear D, Morrison J, Allan L, Henderson A, Smiley E, Cooper SA. Prevalence of physical conditions and multimorbidity in a cohort of adults with intellectual disabilities with and without Down syndrome: cross-sectional study. BMJ Open. 2018;8(2), e018292. 10.1136/bmjopen-2017-018292. - DOI - PMC - PubMed

[7] O’Leary L, Cooper SA, Hughes-McCormack L. Early death and causes of death of people with intellectual disabilities: a systematic review. J Appl Res Intellect Disabil JARID. 2018;31(3):325–342. 10.1111/jar.12417. - DOI - PubMed

[8] O’Leary L, Cooper SA, Hughes-McCormack L. Early death and causes of death of people with intellectual disabilities: a systematic review. J Appl Res Intellect Disabil JARID. 2018;31(3):325–342. 10.1111/jar.12417. - DOI - PubMed

[9] Binkley CJ, Haugh GS, Kitchens DH, Wallace DL, Sessler DI. Oral microbial and respiratory status of persons with mental retardation/intellectual and developmental disability: an observational cohort study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108(5):722–731. 10.1016/j.tripleo.2009.06.027. - DOI - PMC - PubMed

[10] Binkley CJ, Haugh GS, Kitchens DH, Wallace DL, Sessler DI. Oral microbial and respiratory status of persons with mental retardation/intellectual and developmental disability: an observational cohort study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108(5):722–731. 10.1016/j.tripleo.2009.06.027. - DOI - PMC - PubMed

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Predictors of COVID-19 infection and hospitalization in group homes for individuals with intellectual and/or developmental disabilities

Affiliations

Predictors of COVID-19 infection and hospitalization in group homes for individuals with intellectual and/or developmental disabilities

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