Impact of ADRD on Racial Disparities in COVID-19 Outcomes in Nursing Homes
Overview
This cohort study of 127,913 nursing home resident-episodes found that Black residents were more likely than White residents to contract COVID-19 and be hospitalized within 30 days, but not more likely to die. The presence of Alzheimer’s disease and related dementias (ADRDs) exacerbated racial disparities in hospitalization and combined hospitalization or death outcomes.
Background
Nursing home residents are disproportionately affected by COVID-19 due to age, comorbidities, and congregate living conditions. Black residents and those with ADRDs have experienced worse COVID-19 outcomes, potentially due to structural racism and the complex care needs associated with dementia. ADRDs affect nearly half of nursing home residents and may amplify racial disparities in COVID-19 outcomes. Prior studies have been limited by aggregate data or small samples, lacking comprehensive person-level information on ADRD status.
Data Highlights
Outcome
Total Events
Resident-Episodes
Incident COVID-19 infections
15,379
127,913
COVID-19–associated deaths
1,522
127,913
COVID-19–associated hospitalizations
2,548
127,913
Key Findings
Black nursing home residents had higher rates of incident COVID-19 infection compared to White residents.
Black residents were more likely to be hospitalized within 30 days of COVID-19 infection than White residents.
No significant racial difference was observed in 30-day COVID-19–associated mortality.
Racial disparities in hospitalization and combined hospitalization or death were more pronounced among residents with ADRDs.
ADRD status acts as a disparity multiplier, exacerbating racial differences in COVID-19 outcomes.
Clinical Implications
Clinicians and nursing home administrators should recognize that Black residents, especially those with ADRDs, are at increased risk for COVID-19 infection and hospitalization. Enhanced infection control, targeted monitoring, and tailored care strategies are needed for residents with ADRDs to mitigate these disparities. Addressing structural factors contributing to racial disparities is critical for improving outcomes in this vulnerable population.
Conclusion
Racial disparities in COVID-19 outcomes exist among nursing home residents and are intensified by the presence of ADRDs. These findings highlight the need for focused interventions to reduce inequities and improve care for residents with dementia during infectious disease outbreaks.
References
Original Study Authors/2024 -- Impact of Alzheimer’s Disease and Related Dementias on Racial Disparities in COVID-19 Outcomes Among Nursing Home Residents
