COVID Infection, Death Linked to Racial Diversity in Nursing Homes

Jun. 16, 2021

New research shows that people in nursing homes with higher concentrations of Black and Latino residents were more than 50% more likely to be infected with COVID and twice as likely to die in the first months of the pandemic, compared to those in homes with predominately white populations. 

The study, which appears in the journal Infection Control & Hospital Epidemiology, was led by Yue Li, Ph.D., a professor in the University of Rochester Medical Center (URMC) Department of Public Health Sciences.  In previous studies, Li and his colleagues have shown that older residents from underrepresented racial and ethnic backgrounds and their caregivers bore the severest brunt from COVID, and linked the COVID toll in nursing homes to staffing levels and quality scores.  The new study examines what unfolded in nursing homes in the early stages of the coronavirus pandemic.

“The widened across-facility disparities in COVID-19 morbidity and mortality during the early pandemic period are just another manifestation of the structural inequalities in nursing home care that have existed for decades,” said Li.

Researchers analyzed cases and death reports for a 10 week period between April 13 and June 19, 2020 in nursing homes in Connecticut, one of the few states to provide weekly counts early in the pandemic. The case and death reports were analyzed for nursing home characteristics, such as number of beds, ownership, percent of Medicare residents, and staffing levels, as well as county COVID case and death data.

The researchers found immediate disparities in nursing home infections and deaths, which increased as the pandemic progressed.  By week 10 of the study data, the infection rate was 54% higher and the death rate was 117% higher in nursing homes with larger proportions of underrepresented residents compared to those with a whiter population.  The disparities persisting even after accounting for differences in the local infection rate and other nursing home characteristics.

The authors acknowledge that the state and federal response to the pandemic helped mitigate the challenges that many nursing homes faced, including PPE shortages, access to improved testing, and financial support.  However, while lowering infection and death rates overall, these measures have not reduced disparities in care and outcomes. 

“Our findings indicate that although broadly targeted policy and public health measures may have been effective in mitigating coronavirus transmission in nursing homes, they have not helped reduce disparities in COVID outcomes due to systemic inequalities in nursing home care,” said Li. “Going forward, it is imperative that future federal, state, and local initiatives are designed to couple efforts to fight the pandemic and those designed to redress enduring disparities in health outcomes, while also avoiding programs that may perpetuate systematic inequalities and discriminations.”

Additional study co-authors include Xueya Cai, Yunjiao Mao, Zijing Cheng, and Helena Temkin-Greener with URMC.  The study was funded with support from National Institute of Mental Health and the Agency for Healthcare Research and Quality.