Assessment of Coronavirus Disease 2019 Infection and Mortality Rates Among Nursing Homes With Different Proportions of Black Residents.
Assessment of Coronavirus Disease 2019 Infection and Mortality Rates Among Nursing Homes With Different Proportions of Black Residents.
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DOI：
10.1016/j.jamda.2021.02.014
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发表时间：
2021-04
影响因子：
7.6
通讯作者：
Stone PW
中科院分区：
文献类型：
--
作者：
Travers JL;Agarwal M;Estrada LV;Dick AW;Gracner T;Wu B;Stone PW
2019年冠状病毒病（COVID-19）对黑人居民占多数的养老院（NHs）造成了不成比例的影响。我们研究了NHs黑人居民比例与COVID-19感染和死亡之间的关系，考虑了结构性偏差（作为县级因素进行操作）和城市化/乡村性分层。这是一项横断面观察队列研究，使用了LTCfocus、疾病控制和预防中心长期护理设施COVID-19模块和《纽约时报》县级COVID-19数据库的公开数据。估计了忽略和包含设施特征、COVID-19负担和县级固定效应的4个多变量线性回归模型。从2020年1月20日至2020年7月19日，共有11587家美国NHs向美国疾病控制和预防中心报告了COVID-19的数据，并在LTCfocus和《纽约时报》上拥有数据。黑人居民在国民保健服务中的比例（暴露）；COVID-19感染和死亡（主要结果）。黑人居民在NHs中的比例为：无= 3639(31.4%),<20% = 1020(8.8%),20%-49.9% = 1586(13.7%),≥50% = 681(5.9%)，未报告= 4661（40.2%）。有黑人居民的NHs的COVID-19感染和死亡人数明显高于没有黑人居民的NHs。黑人居民≥50%的NHs比没有黑人居民的NHs感染率高13.6个百分点，死亡率高3.5个百分点（P < .001）。虽然设施特征解释了多变量分析中发现的一些差异，但县级因素和乡村性解释了更多的差异。很可能地方属性，如资源、服务和提供者，对公平护理和健康结果很重要，在黑人居民占国民保健制度比例较大的县不容易获得。结构性偏见可能是这些不平等的根源。考虑到NH设置的乡村性，必须向服务于更大比例黑人居民的NHs提供支持。
Coronavirus disease 2019 (COVID-19) has disproportionately impacted nursing homes (NHs) with large shares of Black residents. We examined the associations between the proportion of Black residents in NHs and COVID-19 infections and deaths, accounting for structural bias (operationalized as county-level factors) and stratifying by urbanicity/rurality. This was a cross-sectional observational cohort study using publicly available data from the LTCfocus, Centers for Disease Control and Prevention Long-Term Care Facility COVID-19 Module, and the NYTimes county-level COVID-19 database. Four multivariable linear regression models omitting and including facility characteristics, COVID-19 burden, and county-level fixed effects were estimated. In total, 11,587 US NHs that reported data on COVID-19 to the Centers for Disease Control and Prevention and had data in LTCfocus and NYTimes from January 20, 2020 through July 19, 2020. Proportion of Black residents in NHs (exposure); COVID-19 infections and deaths (main outcomes). The proportion of Black residents in NHs were as follows: none= 3639 (31.4%), <20% = 1020 (8.8%), 20%-49.9% = 1586 (13.7%), ≥50% = 681 (5.9%), not reported = 4661 (40.2%). NHs with any Black residents showed significantly more COVID-19 infections and deaths than NHs with no Black residents. There were 13.6 percentage points more infections and 3.5 percentage points more deaths in NHs with ≥50% Black residents than in NHs with no Black residents (P < .001). Although facility characteristics explained some of the differences found in multivariable analyses, county-level factors and rurality explained more of the differences. It is likely that attributes of place, such as resources, services, and providers, important to equitable care and health outcomes are not readily available to counties where NHs have greater proportions of Black residents. Structural bias may underlie these inequities. It is imperative that support be provided to NHs that serve greater proportions of Black residents while considering the rurality of the NH setting.
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作者：
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期刊：
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影响因子：
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