Factors Associated With Racial Differences in Deaths Among Nursing Home Residents With COVID-19 Infection in the US.
Factors Associated With Racial Differences in Deaths Among Nursing Home Residents With COVID-19 Infection in the US.
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DOI：
10.1001/jamanetworkopen.2020.37431
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发表时间：
2021-02-01
影响因子：
13.8
通讯作者：
Konetzka RT
中科院分区：
文献类型：
--
作者：
Gorges RJ;Konetzka RT
2019冠状病毒病（COVID-19）的病例组合、疗养院特征和社区传播是否与美国感染COVID-19的疗养院居民死亡的种族差异有关？在这项对美国13312家养老院的横断面研究中，与白色居民比例高（> 97%）的养老院相比，白色居民比例低（<60%）的养老院居民感染COVID-19的死亡率更高。死亡率的这种差异与设施特征和位置的差异有关。研究结果表明，普通人群中COVID-19感染和死亡率种族差异背后的不平等也可能与感染COVID-19的养老院居民的死亡率差异有关。重要的是要了解养老院种族组成的2019冠状病毒病（COVID-19）死亡人数的差异以及这些差异的潜在原因，以便公平分配有限的资源。描述按疗养院种族组成划分的COVID-19死亡人数差异，并检查与这些差异相关的因素。这项针对美国13312家养老院的横断面研究使用了医疗保险和医疗补助服务中心的养老院COVID-19公共文件，其中包含养老院居民自2020年1月1日至2020年5月24日期间自2020年9月13日结束的COVID-19病例和死亡人数。数据分析时间为2020年7月28日至12月18日。确诊或疑似COVID-19感染。确诊病例定义为经诊断实验室检测确诊的COVID-19感染。疑似病例定义为COVID-19感染的体征和/或症状，或针对COVID-19感染的患者特定传播预防措施。养老院居民中与COVID-19相关的死亡人数。死亡人数通过疗养院的种族组成进行比较，以白色居民的比例为衡量标准。在纳入研究的13312家养老院中，居民的总体平均（SD）年龄为79.5（6.7）岁。居民中共报告了51606例与COVID-19相关的死亡，平均（SD）为每个设施3.9（8.0）例死亡。白色居民比例最低的养老院（五分位数1）与白色居民比例最高的养老院（五分位数5）的平均（SD）死亡人数分别为5.6（9.2）和1.7（4.8）。五分之一第1类设施的死亡人数平均比五分之一第5类设施多3.9人（0.2人），即五分之一第1类设施的死亡人数是五分之一第5类设施的3.3倍。调整认证床位数量后，这2个养老院组之间的平均（SE）差异降至2.2（0.2）例死亡。控制病例组合措施和其他疗养院的特点并没有改变这种关联。对县级COVID-19患病率的调整进一步将平均（SE）差异降至1.0（0.2）例死亡。在这项研究中，非白色居民比例最高的养老院经历的COVID-19死亡人数是白色居民比例最高的养老院的3.3倍。这些差异与养老院规模较大和非白人居民比例较高的养老院所在县的感染负担较高等因素有关。将有限的可用资源集中在非白人居民比例高的设施上，需要在未来潜在的疫情爆发期间支持养老院。这项横断面研究使用了医疗保险和医疗补助服务中心的数据，以描述养老院居民中COVID-19死亡人数的种族差异，并检查与这些差异相关的因素。
Are case mix, nursing home characteristics, and community spread of coronavirus disease 2019 (COVID-19) associated with racial differences in deaths among nursing home residents with COVID-19 infection in the US? In this cross-sectional study of 13 312 nursing homes in the US, deaths among nursing home residents with COVID-19 infection were higher in facilities that had low proportions (<60%) of White residents compared with those that had high proportions (>97%) of White residents. This difference in mortality was associated with a combination of differences in facility characteristics and location. The study’s findings suggest that the inequalities underlying racial disparities in COVID-19 infection and mortality in the general population may also be associated with differences in mortality among nursing home residents with COVID-19 infection. It is important to understand differences in coronavirus disease 2019 (COVID-19) deaths by nursing home racial composition and the potential reasons for these differences so that limited resources can be distributed equitably. To describe differences in the number of COVID-19 deaths by nursing home racial composition and examine the factors associated with these differences. This cross-sectional study of 13 312 nursing homes in the US used the Nursing Home COVID-19 Public File from the Centers for Medicare and Medicaid Services, which contains COVID-19 cases and deaths among nursing home residents as self-reported by nursing homes beginning between January 1, 2020, and May 24, 2020, and ending on September 13, 2020. Data were analyzed from July 28 to December 18, 2020. Confirmed or suspected COVID-19 infection. Confirmed cases were defined as COVID-19 infection confirmed by a diagnostic laboratory test. Suspected cases were defined as signs and/or symptoms of COVID-19 infection or patient-specific transmission-based precautions for COVID-19 infection. Deaths associated with COVID-19 among nursing home residents. Death counts were compared by nursing home racial composition, which was measured as the proportion of White residents. Among 13 312 nursing homes included in the study, the overall mean (SD) age of residents was 79.5 (6.7) years. A total of 51 606 COVID-19–associated deaths among residents were reported, with a mean (SD) of 3.9 (8.0) deaths per facility. The mean (SD) number of deaths in nursing homes with the lowest proportion of White residents (quintile 1) vs nursing homes with the highest proportions of White residents (quintile 5) were 5.6 (9.2) and 1.7 (4.8), respectively. Facilities in quintile 1 experienced a mean (SE) of 3.9 (0.2) more deaths than those in quintile 5, representing a 3.3-fold higher number of deaths in quintile 1 compared with quintile 5. Adjustment for the number of certified beds reduced the mean (SE) difference between these 2 nursing home groups to 2.2 (0.2) deaths. Controlling for case mix measures and other nursing home characteristics did not modify this association. Adjustment for county-level COVID-19 prevalence further reduced the mean (SE) difference to 1.0 (0.2) death. In this study, nursing homes with the highest proportions of non-White residents experienced COVID-19 death counts that were 3.3-fold higher than those of facilities with the highest proportions of White residents. These differences were associated with factors such as larger nursing home size and higher infection burden in counties in which nursing homes with high proportions of non-White residents were located. Focusing limited available resources on facilities with high proportions of non-White residents is needed to support nursing homes during potential future outbreaks. This cross-sectional study uses data from the Centers for Medicare and Medicaid Services to describe the racial differences in the number of COVID-19 deaths among nursing home residents by the racial composition of the facility and to examine the factors associated with these differences.
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