ORIGINAL RESEARCH article
Front. Public Health
Sec. Aging and Public Health
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1613684
The impact of COVID-19 hospitalizations on nursing home admissions: a regional insight into long-term care and public health
Provisionally accepted
Alessandro Nobili1*
Alessandra Bandera2
Marta Colaneri2
Marta Canuti2
Lucia Dall'Olio2
Massimo Puoti3
Giulia Carla Marchetti2
Simone Piva4
Pierluigi Plebani5Mario Raviglione2
Andrea Gori2
Danilo Cereda6
Olivia Leoni6Ida Fortino6Pasquale Agosti2
Fabrizio Tediosi2
Pier Mannuccio Mannucci7
Maria Luisa Ojeda Fernández1
Marta Baviera1
Mauro Tettamanti1
Alessia Antonella Galbussera1- 1Mario Negri Institute for Pharmacological Research (IRCCS), Milano, Italy
- 2University of Milan, Milan, Lombardy, Italy
- 3Niguarda Ca' Granda Hospital, Milan, Lombardy, Italy
- 4University of Brescia, Brescia, Lombardy, Italy
- 5Fondazione Politecnico di Milano, Milan, Lombardy, Italy
- 6Regione Lombardia, Milano, Italy
- 7IRCCS Ca 'Granda Foundation Maggiore Policlinico Hospital, Milan, Lombardy, Italy
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Background: To obtain the rate of admission to nursing homes (NHs) and to evaluate clinical characteristics and mortality rates of patients admitted to NHs after hospitalizations for COVID-19, compared to non-COVID-19 acutely hospitalized patients. Methods: We analyzed administrative data from Lombardy, a Northen Italian region, in individuals aged >50 years who were hospitalized and discharged alive in 2018 for acute conditions or, between February 2020-June 2022, for COVID-19. Outcomes included NH institutionalization rates within 180 post-discharge day and mortality following NH admission. Kaplan-Meier curves and Cox proportional hazard models adjusted for age, sex, and comorbidities were used to assess the risks. Results: Among 133,216 COVID-19 hospitalizations in 2020-2022 and 239,099 acute hospitalizations in 2018, institutionalization rates within 180 post-discharge days were similar (3.7% for both cohorts). However, COVID-19 patients had higher adjusted risks of institutionalization (HR 1.70; 95% CI 1.63-1.78) and mortality within 6 months after NH admission (HR 2.08; 95% CI 1.90-2.27). Differences were more pronounced when considering patients hospitalized during the first COVID-19 pandemic wave. Conclusion: COVID-19 hospitalization significantly increases the risks of admission to NHs and early mortality after institutionalization in older individuals compared to hospitalizations due to other acute conditions.
Keywords: COVID-19, Administrative databases, Institutionalization, Post-acute care, nursing home
Received: 17 Apr 2025; Accepted: 30 Jun 2025.
Copyright: © 2025 Nobili, Bandera, Colaneri, Canuti, Dall'Olio, Puoti, Marchetti, Piva, Plebani, Raviglione, Gori, Cereda, Leoni, Fortino, Agosti, Tediosi, Mannucci, Ojeda Fernández, Baviera, Tettamanti and Galbussera. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Alessandro Nobili, Mario Negri Institute for Pharmacological Research (IRCCS), Milano, Italy
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