Nursing homes with more minority residents had 3 times as many Covid deaths as those with more Whites, study finds

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Derede McAlpin holds a photo of her mother, 92-year-old Sara McAlpin, who was diagnosed with Covid-19 in Rockville, MD.
Katherine Frey | The Washington Post | Getty Images

Nursing homes with more minority residents reported more than three times as many Covid deaths as those that had more White residents, a large study published Wednesday found.

The University of Chicago researchers looked at 13,312 U.S. nursing homes and analyzed Covid data reported to the Centers for Disease Control and Prevention from May to December. They found that nursing homes where more than 40% of their residents were Black or Hispanic reported 3.3 times as many Covid deaths and cases as nursing homes that had more White residents.

Nursing homes and other long-term care facilities have been hit hardest by the pandemic. Fewer than 1% of Americans live in such facilities, the CDC says, but they have accounted for almost 40% of all U.S. Covid deaths, according to data from the COVID Tracking Project.

It’s well documented that the pandemic has taken a disproportionate toll on ethnic and racial minorities in the United States. President Joe Biden and his administration have vowed to ensure equity throughout the vaccine distribution process, prioritizing communities of color that have been hit disproportionately hard by the pandemic.

The new study, published in The Journal of the American Medical Association, shows how those disparities extend into nursing homes, and it carries policy implications for vaccine distribution.

The disparities were driven by a few historical factors, the researchers said. Minority residents of nursing homes, for example, are more likely to live in large facilities that are for-profit, more reliant on Medicaid and “have deficiencies in care,” the researchers said. They added that “nursing homes are highly segregated” in the U.S.

A medic from Empress EMS loads a suspected COVID-19 patient into an ambulance on April 07, 2020 in Yonkers, New York.
John Moore | Getty Images

“Before the COVID-19 pandemic began, it was well established that racial disparities in the quality of nursing home care were common,” the authors wrote. “Relative to White individuals, Black individuals are more likely to be admitted to the lowest-quality nursing homes, which have lower nurse staffing ratios, more serious regulatory deficiencies, and a higher likelihood of being terminated from the Medicaid program.”

The researchers, health economists Rebecca Gorges and Tamara Konetzka, added that the pandemic is something of “a perfect storm” for nursing home residents.

“Because minority communities experience the highest rates of COVID-19 infection and nursing homes in those communities are generally of lower quality, non-White nursing home residents are in the eye of that perfect storm,” they wrote.

The study notes that the Covid death toll in U.S. nursing homes will likely begin to drop soon with the vaccine rollout. The CDC recommends that states prioritize offering the vaccine to residents and workers in long-term care facilities before moving on to other parts of the population.

The Federal Pharmacy Partnership for Long-Term Care Program allowed states to tap pharmacies like CVS and Walgreens to help distribute the vaccine. Through that program, more than 5 million doses have been administered to long-term care residents and staff as of Tuesday, according to the CDC.

“As vaccination proceeds, it will be important for policymakers to consider existing inequities to ensure that the process of vaccine distribution includes particular efforts to reach communities of color,” the researchers wrote in the study.

They noted a few limitations of their study. While facility-level data are publicly available through the CDC, they said comprehensive individual-level data is not available. Such data “are needed to understand whether there are within-facility disparities in addition to the between-facility disparities,” they said.

They added that the data they analyzed was self-reported by nursing homes beginning in May, which omitted many cases and deaths that occurred before then. And, they said, the federal data “did not allow for racial classifications other than White, Black, and Hispanic.” More detailed data, they said, would have allowed for further analysis of the data across diverse racial groups.

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