United States Nursing Homes and Health Equity During the COVID-19 Pandemic

Objective: The COVID-19 pandemic disproportionately affected older populations, with nursing homes impacted early on by the disease. The contribution of race/ethnicity of nursing home residents and facility characteristics on COVID-19 were unknown. The Donabedian model framework was used to study the relationship between the racial/ethnic characteristics of nursing home residents and COVID-19 outcomes and to examine if this relationship was moderated by the racial/ethnic composition of the county of nursing home location. Method: Cross-sectional research design merging data from five publicly available sources. Laboratory confirmed COVID-19 cases and deaths were compared by the racial composition of the county and nursing home. Firth logistic regression model and two zero-inflated negative binomial regression models were run to address the study aims. Statistical significance was assessed at p Results: 14,405 nursing homes examined this study. These facilities reported a mean confirmed COVID-19 cases and deaths of 45 and 8, respectively. The interaction of nursing home location and resident racial composition was associated with the number of nursing home COVID-19 deaths. Conclusion: Location characteristics of nursing homes in conjunction with a predominantly minority nursing home resident population did not play a role in the number of COVID-19 cases but did impact COVID-19 deaths. Standardized safety measures implemented in nursing homes seemed to help minimize differences in COVID-19 cases between nursing facilities. Historical health inequality for minority populations and social determinants of health are factors that could have increased the number of deaths for minority residents