Neither Race nor Ethnicity Impact the Mortality of Residents of Veterans Affairs Community Living Center With COVID-19.
Nursing homes
SARS-CoV-2
health care disparities
long-term care
Journal
Journal of the American Medical Directors Association
ISSN: 1538-9375
Titre abrégé: J Am Med Dir Assoc
Pays: United States
ID NLM: 100893243
Informations de publication
Date de publication:
01 2023
01 2023
Historique:
received:
03
08
2022
revised:
26
10
2022
accepted:
30
10
2022
pubmed:
4
12
2022
medline:
10
1
2023
entrez:
3
12
2022
Statut:
ppublish
Résumé
COVID-19 disproportionately affected nursing home residents and people from racial and ethnic minorities in the United States. Nursing homes in the Veterans Affairs (VA) system, termed Community Living Centers (CLCs), belong to a national managed care system. In the period prior to the availability of vaccines, we examined whether residents from racial and ethnic minorities experienced disparities in COVID-19 related mortality. Retrospective cohort study. Residents at 134 VA CLCs from April 14 to December 10, 2020. We used the VA Corporate Data Warehouse to identify VA CLC residents with a positive SARS-CoV-2 polymerase chain reaction test during or 2 days prior to their admission and without a prior case of COVID-19. We assessed age, self-reported race/ethnicity, frailty, chronic medical conditions, Charlson comorbidity index, the annual quarter of the infection, and all-cause 30-day mortality. We estimated odds ratios and 95% confidence intervals of all-cause 30-day mortality using a mixed-effects multivariable logistic regression model. During the study period, 1133 CLC residents had an index positive SARS-CoV-2 test. Mortality at 30 days was 23% for White non-Hispanic residents, 15% for Black non-Hispanic residents, 10% for Hispanic residents, and 16% for other residents. Factors associated with increased 30-day mortality were age ≥70 years, Charlson comorbidity index ≥6, and a positive SARS-CoV-2 test between April 14 and June 30, 2020. Frailty, Black race, and Hispanic ethnicity were not independently associated with an increased risk of 30-day mortality. Among a national cohort of VA CLC residents with COVID-19, neither Black race nor Hispanic ethnicity had a negative impact on survival. Further research is needed to determine factors within the VA health care system that mitigate the influence of systemic racism on COVID-19 outcomes in US nursing homes.
Identifiants
pubmed: 36462546
pii: S1525-8610(22)00831-3
doi: 10.1016/j.jamda.2022.10.020
pmc: PMC9633636
pii:
doi:
Types de publication
Journal Article
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
22-26.e1Informations de copyright
Published by Elsevier Inc.
Références
J Gerontol A Biol Sci Med Sci. 2021 Jun 14;76(7):1318-1325
pubmed: 33693638
J Am Med Dir Assoc. 2022 Feb;23(2):214-219
pubmed: 34958742
J Am Med Dir Assoc. 2021 Jul;22(7):1345-1351
pubmed: 34062147
JAMA Netw Open. 2021 Feb 1;4(2):e2037431
pubmed: 33566110
Med Care. 2005 Nov;43(11):1130-9
pubmed: 16224307
Med Care. 2021 Dec 1;59(12):1082-1089
pubmed: 34779794
J Natl Med Assoc. 2009 Jul;101(7):656-62
pubmed: 19634586
Public Health Rep. 2016 Nov;131(6):839-843
pubmed: 28123232
JAMA Netw Open. 2021 Mar 1;4(3):e216315
pubmed: 33787905
Public Health Rep. 2021 Jul-Aug;136(4):483-492
pubmed: 33826875
J Am Geriatr Soc. 2021 Oct;69(10):2766-2777
pubmed: 34549415
PLoS Med. 2020 Sep 22;17(9):e1003379
pubmed: 32960880
JAMA Intern Med. 2021 Apr 1;181(4):439-448
pubmed: 33394006
J Am Med Dir Assoc. 2021 May;22(5):966-970.e3
pubmed: 33775597
Arch Intern Med. 2000 Nov 27;160(21):3252-7
pubmed: 11088086
J Am Coll Cardiol. 2004 Mar 3;43(5):778-84
pubmed: 14998616
J Am Geriatr Soc. 2020 Nov;68(11):2454-2461
pubmed: 32955105
J Infect Dis. 2022 Feb 15;225(4):567-577
pubmed: 34618896