Abstract
Racial/ethnic disparities in healthcare have been highlighted by the recent COVID-19 pandemic. Using the Centers for Medicare and Medicaid Services' Nursing Home COVID-19 Public File, this study examined the relationship between nursing home racial/ethnic mix and COVID-19 resident mortality. As of October 25, 2020, high minority nursing homes reported 6.5 COVID-19 deaths as compared to 2.6 deaths for nursing homes that had no racial/ethnic minorities. After controlling for interstate differences, facility-level resident characteristics, resource availability, and organizational characteristics, high-minority nursing homes had 61% more COVID-19 deaths [Incidence Rate Ratio (IRR) = 1.61; p < 0.001] as compared to nursing facilities with no minorities. From a policy perspective, nursing homes, that serve primarily minority populations, may need additional resources, such as, funding for staffing and personal protective equipment in the face of the pandemic. The COVID-19 pandemic has sharpened the focus on healthcare disparities and societal inequalities in the delivery of long-term care.
Highlights
COVID-19 is disproportionately affecting older individuals and those with underlying chronic health care conditions
Model 2 shows that nursing homes with a higher proportion of older residents and hypertension had greater COVID-19 mortality (p < 0.001)
Nursing homes with a higher proportion of residents with congestive heart failure, obesity, and worse acuity were at greater risk of COVID-19 mortality (p < 0.05)
Summary
COVID-19 is disproportionately affecting older individuals and those with underlying chronic health care conditions. The congregate nature of nursing homes and the average acuity of residents place them at higher risk of serious complications due to COVID-19, including death. More than 40% of COVID-19 deaths have been attributed to nursing home residents [1]. As Whites sought long-term care outside of the nursing home, Hispanics and Blacks increased their utilization of nursing homes [4]. Blacks account for 15% of all nursing home residents, Hispanics 6%, and Whites 79%. Minorities on average receive care from relatively lower quality providers and have worse health outcomes, which may increase the risk of mortality as it relates to COVID-19 [5]
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