Racial and Ethnic Disparities inCOVID-19Infections and Deaths Across US Nursing Homes
Racial and Ethnic Disparities inCOVID-19Infections and Deaths Across US Nursing Homes
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DOI：
10.1111/jgs.16847
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发表时间：
2020-09-28
影响因子：
6.3
通讯作者：
Temkin-Greener, Helena
中科院分区：
文献类型：
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作者：
Li, Yue;Cen, Xi;Temkin-Greener, Helena
背景/目的确定疗养院居民或工作人员每周新发新冠肺炎病例和死亡人数的种族/民族差异。设计横断面分析，将全国养老院新冠肺炎报告与其他数据联系起来。多变量两部分模型模拟了病例或死亡人数的差异，Logistic回归模拟了疗养院群体中自我报告的人员和个人防护装备(PPE)短缺的差异，养老院群体具有不同比例的种族/少数民族居民，定义为低、中、中、高和高比例群体。在全国范围内设立了12576家养老院。参与者无。无干预。衡量居民和工作人员中确诊的新冠肺炎事件病例数量，以及居民中与新冠肺炎事件相关的死亡人数(主要结果)；以及疗养院报告的工作人员和个人防护用品短缺(次要结果)。所有结果都报告了2020年5月25日的一周。结果低比例组(93.0%为零新发病例)平均每机构0.4例(标准差(SD=2.5))至高比例组(78.9%为零新发病例)每机构1.5例(SD=6.3)。多变量回归估计，与低比例组相比，高比例组至少有一个新的居民病例的可能性高76%(优势比=1.76；95%可信区间=1.38-2.25；P=.000)。各机构在居民每周新增新冠肺炎死亡病例计数(低比例组从每个机构0.1例死亡(SD=1.1)到高比例组0.4例死亡(SD=2.0))和工作人员每周新确诊新冠肺炎病例(从每个机构0.3例(SD=1.4)到1.3例(SD=4.4))方面发现了类似的差异。在自我报告的工作人员短缺或个人防护装备短缺方面，没有发现实质性差异。结论照顾更多种族/少数民族居民的养老院每周报告更多的新冠肺炎确诊病例和/或死亡。需要立即采取行动来解决这些系统层面的差异。
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.