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

Julie H Levison; Vicki Fung; Anna Wilson; David Cheng; Karen Donelan; Nicolas M Oreskovic; Ronita Samuels; Paula Silverman; Joey Batson; Ahmed Fathi; Stefanie Gamse; Sibyl Holland; Jessica E Becker; Kenneth A Freedberg; Lisa I Iezzoni; Amy Donohue; Mark Viron; Carley Lubarsky; Terina Keller; Jean-Louise Reichman; Bettina Bastien; Elizabeth Ryan; Alexander C Tsai; John Hsu; Cindy Chau; David Krane; Hao D Trieu; Jessica Wolfe; Kim Shellenberger; Elizabeth Cella; Bruce Bird; Stephen Bartels; Brian G Skotko

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

Disabil Health J. 2024 Oct;17(4):101645. doi: 10.1016/j.dhjo.2024.101645. Epub 2024 Jun 5.

Authors

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: [email protected].
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.

MeSH terms

Adolescent
Adult
Aged
COVID-19* / epidemiology
Developmental Disabilities* / epidemiology
Disabled Persons / statistics & numerical data
Female
Group Homes* / statistics & numerical data
Hospitalization* / statistics & numerical data
Humans
Intellectual Disability* / epidemiology
Male
Massachusetts / epidemiology
Middle Aged
Proportional Hazards Models
Risk Factors
SARS-CoV-2
Young Adult

Grants and funding

T32 HS000063/HS/AHRQ HHS/United States