Assessment of Coronavirus Disease 2019 Infection and Mortality Rates Among Nursing Homes With Different Proportions of Black Residents.
Jasmine L Travers, Mansi Agarwal, Leah V Estrada and 4 others
PMID 33762185WHAT IT FOUND
Nursing homes with more Black residents had higher rates of COVID-19 infections and deaths than those with no Black residents.
Adjusting for facility characteristics and county burden reduced these differences, suggesting structural factors beyond individual nursing home practices drove the disparities.
Key findings
01Nursing homes with any proportion of Black residents had at least twice as many COVID-19 deaths per occupied bed compared to nursing homes with no Black residents.
02The association between higher proportions of Black residents and increased infections or deaths attenuated almost entirely when county-level fixed effects were included in the models.
03Disparities in infections and deaths were stronger in rural settings with higher proportions of Black residents than in urban settings.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Race data were from 2017 assessments, potentially outdated for 2020 outcomes. 40% of nursing homes were missing race data and were classified as 'not reported'. County-level data lack specificity for drawing conclusions about local structural bias. The study could not account for county fixed effects in the stratified rural analysis due to sample size. Infection and death counts depend on testing availability, which was likely lower in under-resourced facilities, possibly underestimating true disparities.
Declared interests
The study was supported by the National Institute on Aging (N.I.H., Extramural). No other conflicts of interest are declared in the provided text.
The easy way to misread this
Do not conclude that nursing homes with more Black residents inherently provide worse care or have worse outcomes due to the residents themselves. The attenuation of disparities after adjusting for county fixed effects indicates that broader structural and community-level factors, such as resource scarcity and historical bias, are the primary drivers of the observed differences.