Socio-spatial health disparities in Covid-19 cases and deaths in United States skilled nursing facilities over 30 months

Abstract

This study investigated whether socio-spatial factors surrounding United States skilled nursing facilities related to Covid-19 case counts among residents, staff, and facility personnel and deaths among residents. With data on 12,403 United States skilled nursing facilities and Census data we estimated multilevel models to assess relationships between facility and surrounding area characteristics from June 2020 to September 2022 for cumulative resident and facility personnel case counts and resident deaths. Facilities with more Black or Latino residents experienced more cases incident rate ratios (IRR=1.005; 1.004) and deaths (IRR=1.008) among residents during the first 6 months of the pandemic but were no different thereafter. Facilities with more racial and ethnic heterogeneity and percent Black or Latino in the surrounding buffer experienced more Covid-19 cases and deaths in the first 6 months, but no such differences were observed in the subsequent 24 months. Facilities surrounded by higher percent Latino consistently experienced more cases among staff and facility personnel over the study period (IRR=1.006; 1.001). Findings indicated socio-spatial health disparities in cases among residents, staff, and facility personnel in the first 6 months of the pandemic, with some disparities fading thereafter. This pattern likely suggests the importance of the adoption and adherence to pandemic-related safety measures in skilled nursing facilities nationwide.