Assessment of COVID-19 Infection and Mortality Rates Among Nursing Homes with Different Proportions of Black Residents

Abstract Objective 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. Design This was a cross-sectional observational cohort study using publicly available data from the LTCfocus, Centers for Disease Control and Prevention (CDC) 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. Setting and Participants: 11,587 US NHs that reported data on COVID-19 to the CDC and had data in LTCfocus and NYTimes from January 20th, 2020 through July 19th, 2020. Measures Proportion of Black residents in NHs (exposure); COVID-19 infections and deaths (main outcomes). Results The proportion of Black residents in NHs were as follows: none= 3,639 (31.4%), Conclusions and Implications 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.