Dataset Information

Racial and Ethnic Disparities in COVID-19 Infections and Deaths Across U.S. Nursing Homes.

ABSTRACT:

Background/objectives

To determine racial/ethnic disparities in weekly counts of new COVID-19 cases and deaths among nursing home residents or staff.

Design

Cross-sectional analysis of national nursing home COVID-19 reports linked to other data. Multivariable two-part models modeled disparities in count of cases or deaths, and logistic regressions modeled disparities in self-reported shortages in staff and personal protective equipment (PPE), across nursing home groups with varying proportions of racial/ethnic minority residents, defined as low-, medium-, medium-high-, and high-proportion groups.

Setting

A total of 12,576 nursing homes nationally.

Participants

None.

Intervention

None.

Measurements

Numbers of incident COVID-19 confirmed cases among residents and staff, and incident COVID-19 related deaths among residents (primary outcomes); and nursing home reported shortages in staff and PPE (secondary outcomes). All outcomes were reported for the week of May 25, 2020.

Results

The number of weekly new COVID-19 confirmed cases among residents ranged from an average of 0.4 cases per facility (standard deviation (SD) = 2.5) for the low-proportion group (93.0% had zero new cases) to 1.5 cases per facility (SD = 6.3) for the high-proportion group (78.9% had zero new cases). Multivariable regression estimated that compared with the low-proportion group, the likelihood of having at least one new resident case was 76% higher (odds ratio = 1.76; 95% confidence interval = 1.38-2.25; P = .000) for the high-proportion group. Similar across-facility disparities were found for the weekly count of new COVID-19 deaths among residents (ranging from 0.1 deaths per facility (SD = 1.1) for the low-proportion group to 0.4 deaths (SD = 2.0) for the high-proportion group) and in the weekly count of new COVID-19 confirmed cases among staff (ranging from 0.3 cases (SD = 1.4] to 1.3 cases (SD = 4.4) per facility). No substantial disparities in self-reported shortages of staff or PPE were found.

Conclusion

Nursing homes caring for disproportionately more racial/ethnic minority residents reported more weekly new COVID-19 confirmed cases and/or deaths. Immediate actions are needed to address these system-level disparities.

SUBMITTER: Li Y

PROVIDER: S-EPMC7537079 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Racial and Ethnic Disparities in COVID-19 Infections and Deaths Across U.S. Nursing Homes.

Li Yue Y Cen Xi X Cai Xueya X Temkin-Greener Helena H

Journal of the American Geriatrics Society 20200928 11

<h4>Background/objectives</h4>To determine racial/ethnic disparities in weekly counts of new COVID-19 cases and deaths among nursing home residents or staff.<h4>Design</h4>Cross-sectional analysis of national nursing home COVID-19 reports linked to other data. Multivariable two-part models modeled disparities in count of cases or deaths, and logistic regressions modeled disparities in self-reported shortages in staff and personal protective equipment (PPE), across nursing home groups with varyin ...[more]

PMID: 32955105

Similar Datasets

Project description:BackgroundData suggest that the effects of coronavirus disease 2019 (COVID-19) differ among U.S. racial/ethnic groups.PurposeTo evaluate racial/ethnic disparities in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection rates and COVID-19 outcomes, factors contributing to disparities, and interventions to reduce them.Data sourcesEnglish-language articles in MEDLINE, PsycINFO, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus, searched from inception through 31 August 2020. Gray literature sources were searched through 2 November 2020.Study selectionObservational studies examining SARS-CoV-2 infections, hospitalizations, or deaths by race/ethnicity in U.S. settings.Data extractionSingle-reviewer abstraction confirmed by a second reviewer; independent dual-reviewer assessment of quality and strength of evidence.Data synthesis37 mostly fair-quality cohort and cross-sectional studies, 15 mostly good-quality ecological studies, and data from the Centers for Disease Control and Prevention and APM Research Lab were included. African American/Black and Hispanic populations experience disproportionately higher rates of SARS-CoV-2 infection, hospitalization, and COVID-19-related mortality compared with non-Hispanic White populations, but not higher case-fatality rates (mostly reported as in-hospital mortality) (moderate- to high-strength evidence). Asian populations experience similar outcomes to non-Hispanic White populations (low-strength evidence). Outcomes for other racial/ethnic groups have been insufficiently studied. Health care access and exposure factors may underlie the observed disparities more than susceptibility due to comorbid conditions (low-strength evidence).LimitationsSelection bias, missing race/ethnicity data, and incomplete outcome assessments in cohort and cross-sectional studies must be considered. In addition, adjustment for key demographic covariates was lacking in ecological studies.ConclusionAfrican American/Black and Hispanic populations experience disproportionately higher rates of SARS-CoV-2 infection and COVID-19-related mortality but similar rates of case fatality. Differences in health care access and exposure risk may be driving higher infection and mortality rates.Primary funding sourceDepartment of Veterans Affairs, Veterans Health Administration, Health Services Research & Development. (PROSPERO: CRD42020187078).

Project description:BackgroundCardiovascular deaths increased during the early phase of the COVID-19 pandemic in the United States. However, it is unclear whether diverse racial/ethnic populations have experienced a disproportionate rise in heart disease and cerebrovascular disease deaths.MethodsWe used the National Center for Health Statistics to identify heart disease and cerebrovascular disease deaths for non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, and Hispanic individuals from March to August 2020 (pandemic period), as well as for the corresponding months in 2019 (historical control). We determined the age- and sex-standardized deaths per million by race/ethnicity for each year. We then fit a modified Poisson model with robust SEs to compare change in deaths by race/ethnicity for each condition in 2020 versus 2019.ResultsThere were a total of 339 076 heart disease and 76 767 cerebrovascular disease deaths from March through August 2020, compared with 321 218 and 72 190 deaths during the same months in 2019. Heart disease deaths increased during the pandemic in 2020, compared with the corresponding period in 2019, for non-Hispanic White (age-sex standardized deaths per million, 1234.2 versus 1208.7; risk ratio for death [RR], 1.02 [95% CI, 1.02-1.03]), non-Hispanic Black (1783.7 versus 1503.8; RR, 1.19 [95% CI, 1.17-1.20]), non-Hispanic Asian (685.7 versus 577.4; RR, 1.19 [95% CI, 1.15-1.22]), and Hispanic (968.5 versus 820.4; RR, 1.18 [95% CI, 1.16-1.20]) populations. Cerebrovascular disease deaths also increased for non-Hispanic White (268.7 versus 258.2; RR, 1.04 [95% CI, 1.03-1.05]), non-Hispanic Black (430.7 versus 379.7; RR, 1.13 [95% CI, 1.10-1.17]), non-Hispanic Asian (236.5 versus 207.4; RR, 1.15 [95% CI, 1.09-1.21]), and Hispanic (264.4 versus 235.9; RR, 1.12 [95% CI, 1.08-1.16]) populations. For both heart disease and cerebrovascular disease deaths, Black, Asian, and Hispanic populations experienced a larger relative increase in deaths than the non-Hispanic White population (interaction term, P<0.001).ConclusionsDuring the COVID-19 pandemic in the United States, Black, Hispanic, and Asian populations experienced a disproportionate rise in deaths caused by heart disease and cerebrovascular disease, suggesting that these groups have been most impacted by the indirect effects of the pandemic. Public health and policy strategies are needed to mitigate the short- and long-term adverse effects of the pandemic on the cardiovascular health of diverse populations.

Project description:Background/objectivesNursing homes have experienced a disproportionate share of COVID-19 cases and deaths. Early analyses indicated that baseline quality was not predictive of nursing home cases, but a more nuanced study of the role of nurse staffing is needed to target resources and better respond to future outbreaks. We sought to understand whether baseline nurse staffing is associated with the presence of COVID-19 in nursing homes and whether staffing impacts outbreak severity.DesignWe analyzed Centers for Medicare & Medicaid Services (CMS) facility-level data on COVID-19 cases and deaths merged with nursing home and county characteristics. We used logistic regressions to examine the associations of staffing levels from Nursing Home Compare with the outcomes of any COVID-19 cases and, conditional on at least one case, an outbreak. Among facilities with at least one case, we modeled count of deaths using hurdle negative binomial-2 regressions.SettingAll nursing homes in the CMS COVID-19 Nursing Home Dataset with reports that passed the CMS Quality Assurance Check as of June 25, 2020.ParticipantsResidents of nursing homes that met COVID-19 reporting requirements.MeasurementsA nursing home is defined as having at least one case is if one or more confirmed or suspected COVID-19 case among residents or staff is reported. Conditional on at least one case, we examine two outcomes: an outbreak, defined as confirmed cases/certified beds >10% or total confirmed and suspected cases/beds >20% or >10 deaths, and the total number of deaths attributed to COVID-19 among residents and staff.ResultsA total of 71% of the 13,167 nursing homes that reported COVID-19 data as of June 14 had at least one case among residents and/or staff. Of those, 27% experienced an outbreak. Higher registered nurse-hours are associated with a higher probability of experiencing any cases. However, among facilities with at least one case, higher nurse aide (NA) hours and total nursing hours are associated with a lower probability of experiencing an outbreak and with fewer deaths. The strongest predictor of cases and outbreaks in nursing homes is per capita cases in the county.ConclusionThe prevalence of COVID-19 in the community remains the strongest predictor of COVID-19 cases and deaths in nursing homes, but higher NA hours and total nursing hours may help contain the number of cases and deaths.

Project description:ImportanceLong-term nursing home stay or death (long-term NH stay or death), defined as new long-term residence in a nursing home or death following hospital discharge, is an important patient-centered outcome.ObjectiveTo examine whether the COVID-19 pandemic was associated with changes in long-term NH stay or death among older adults with sepsis, and whether these changes were greater in individuals from racial and ethnic minoritized groups.Design, setting, and participantsThis cross-sectional study used patient-level data from the Medicare Provider Analysis and Review File, the Master Beneficiary Summary File, and the Minimum Data Set. Community-dwelling individuals aged at least 65 years hospitalized with sepsis between January 2016 and June 2021 were included. Data were analyzed from May to November 2024.ExposureRace and ethnicity and the COVID-19 pandemic.Main outcomes and measuresPatients discharged alive experienced long-term NH stay or death if they resided in a nursing home more than 100 days after hospital discharge and had no period at home greater than 30 days, or died more than 30 days following hospital discharge. Interrupted time series analysis was used to evaluate the association between long-term NH stay or death and the pandemic and race and ethnicity.ResultsA total of 2 964 517 hospitalizations for sepsis of community-dwelling patients discharged alive (1 468 754 [49.5%] female; 19 549 [0.7%] American Indian or Alaska Native, 95 308 [3.2%] Asian or Pacific Islander, 282 646 [9.5%] Black, 279 011 [9.4%] Hispanic, 2 288 003 [71.2%] White individuals; mean [SD] age, 76 [8.3] years) were included. Compared with non-Hispanic White individuals, Black individuals were more likely to experience long-term NH stay or death (adjusted odds ratio [aOR], 1.33; 95% CI, 1.30-1.37; P < .001), while Asian or Pacific Islander (aOR, 0.79; 95% CI, 0.75-0.83; P < .001), Hispanic (aOR, 0.72; 95% CI, 0.70-0.74; P < .001), and American Indian or Alaska Native (aOR, 0.79; 95% CI, 0.72-0.87; P < .001) individuals were less likely to experience long-term NH stay or death. Long-term NH stay or death declined from 13.5% in the first quarter of 2016 to 6.9% in the first quarter of 2020. After adjustment, long-term NH stay or death decreased each quarter (aOR, 0.958; 95% CI, 0.957-0.959; P < .001) before the pandemic. The pandemic was associated with increased risk of long-term NH stay or death over time (aOR, 1.03; 95% CI, 1.02-1.04; P < .001 [each quarter]) compared with before the pandemic for non-Hispanic White individuals. The pandemic was not associated with differential changes in long-term NH stay or death for minoritized individuals compared with non-Hispanic White individuals.Conclusions and relevanceIn this cross-sectional study, older adults hospitalized with sepsis experienced an approximately 50% reduction in long-term NH stay or death over a 5-year period before the pandemic. These results suggest that during the pandemic, all individuals, regardless of race and ethnicity, experienced increased long-term NH stay or death compared with before the pandemic.

Dataset Information

Racial and Ethnic Disparities in COVID-19 Infections and Deaths Across U.S. Nursing Homes.

Background/objectives

Design

Setting

Participants

Intervention

Measurements

Results

Conclusion

Publications

Racial and Ethnic Disparities in COVID-19 Infections and Deaths Across U.S. Nursing Homes.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets