Factors Associated With Racial Differences in Deaths Among Nursing Home Residents With COVID-19 Infection in the US
Open accessAbstract
Importance: It is important to understand differences in coronavirus disease 2019 (COVID-19) deaths by nursing home racial composition and the potential reasons for these differences so that limited resources can be distributed equitably. Objective: To describe differences in the number of COVID-19 deaths by nursing home racial composition and examine the factors associated with these differences. Design, Setting, and Participants: This cross-sectional study of 13 312 nursing homes in the US used the Nursing Home COVID-19 Public File from the Centers for Medicare and Medicaid Services, which contains COVID-19 cases and deaths among nursing home residents as self-reported by nursing homes beginning between January 1, 2020, and May 24, 2020, and ending on September 13, 2020. Data were analyzed from July 28 to December 18, 2020. Exposures: Confirmed or suspected COVID-19 infection. Confirmed cases were defined as COVID-19 infection confirmed by a diagnostic laboratory test. Suspected cases were defined as signs and/or symptoms of COVID-19 infection or patient-specific transmission-based precautions for COVID-19 infection. Main Outcomes and Measures: Deaths associated with COVID-19 among nursing home residents. Death counts were compared by nursing home racial composition, which was measured as the proportion of White residents. Results: Among 13 312 nursing homes included in the study, the overall mean (SD) age of residents was 79.5 (6.7) years. A total of 51 606 COVID-19-associated deaths among residents were reported, with a mean (SD) of 3.9 (8.0) deaths per facility. The mean (SD) number of deaths in nursing homes with the lowest proportion of White residents (quintile 1) vs nursing homes with the highest proportions of White residents (quintile 5) were 5.6 (9.2) and 1.7 (4.8), respectively. Facilities in quintile 1 experienced a mean (SE) of 3.9 (0.2) more deaths than those in quintile 5, representing a 3.3-fold higher number of deaths in quintile 1 compared with quintile 5. Adjustment for the number of certified beds reduced the mean (SE) difference between these 2 nursing home groups to 2.2 (0.2) deaths. Controlling for case mix measures and other nursing home characteristics did not modify this association. Adjustment for county-level COVID-19 prevalence further reduced the mean (SE) difference to 1.0 (0.2) death. Conclusions and Relevance: In this study, nursing homes with the highest proportions of non-White residents experienced COVID-19 death counts that were 3.3-fold higher than those of facilities with the highest proportions of White residents. These differences were associated with factors such as larger nursing home size and higher infection burden in counties in which nursing homes with high proportions of non-White residents were located. Focusing limited available resources on facilities with high proportions of non-White residents is needed to support nursing homes during potential future outbreaks.
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59% of US nursing home residents are women.
“59% of nursing home residents are women”
From Excess deaths associated with covid-19 pandemic in 2020: age and sex disaggregated time series analysis in 29 high income countries (2021) · cites this paper as [70]
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Nursing Home Segregation and Quality of Care
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Autonomy, Identity, and Design in the COVID-19 Era
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Effects of essential caregiver policies on COVID‐19 and non‐COVID‐19 deaths in nursing homes
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Nursing Home Vulnerabilities amid COVID-19 Pandemic: A Study of Midwestern States
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Effects of Essential Caregiver Policies on Covid-19 and Non-Covid-19 Deaths in Nursing HomesPreprint
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“22 See Table 1 for study outcomes.”
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“Proportions of residents who were dually eligible for Medicare and Medicaid (Hughes et al., 2000), Hispanic, Black, and diagnosed with ADRD were calculated from individual-level records in the 2018 MBSF and MDS 3.0 fi le (Chen et al., 2021; Gorges & Konetzka, 2021; Li et al., 2020).”
InfluentialMethods for studying health disparities in U.S. nursing homes: a scoping review
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“Gorges and Konetzka [67] demonstrated facility-level differences in QoC based on the proportion of residents with Medicaid coverage at the facility.”
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“One US study found long-term care facilities with the highest proportions of non-White residents experienced 3.3-fold higher COVID- 19-related deaths than facilities with the highest proportions of White residents [20].”
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- Authors
- Gorges, R. J., & Konetzka, R. T.
- Affiliations
- University of Chicago (US)
- Corresponding author
- Gorges, Rebecca J.
- Venue
- JAMA Network Open
- Publisher
- American Medical Association (AMA)
- Published
- 2021-02-10
- Volume
- 4
- Issue
- 2
- Pages
- e2037431
- ISSN
- 2574-3805 (ISSN-L)
- PMC
- PMC7876590
- OpenAlex
- W3128068547
- Cited by
- 77
- References
- 18
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 12 · 2023: 14 · 2022: 18 · 2021: 23
- FWCI
- 18.82
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JAMA Network Open (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Knowledge@UChicago (University of Chicago) (submittedVersion, cc-by-nc-nd)
- University of Chicago (cc-by)
- Funders
- National Institute on Aging (T32AG000243)
- Topics
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Keywords
- COVID-19 mortality, racial disparities, racial diversity, white residents, case mix, nursing home staffing
- MeSH terms
- Race Factors, COVID-19, SARS-CoV-2, Aged, Aged, 80 and over, Cause of Death, Cross-Sectional Studies, Disease Outbreaks, Medicare, Homes for the Aged, Humans, Medicaid, Nursing Homes, United States, Infection Control, Racial Groups
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