Nursing Homes

This article by Gorges & Konetzka uses data from over 13,000 US nursing homes to determine whether case mix, facility characteristics, and community spread were associated with racial differences in COVID-19-associated deaths among residents. The study found that resident deaths due to COVID-19 were over 3 times higher in facilities that had fewer white residents (<60%) compared to those with high proportions of white residents (>97%). Differences by race were associated with nursing home size and community-level outbreak severity, while aggregate health status of residents made little difference. The findings suggest that inequalities underlying racial disparities in infection and mortality in the general population may also be associated with differences in mortality among nursing home residents. These findings are in line with other data consistently showing that COVID-19-related deaths have been disproportionately higher among persons from racial and ethnic minority groups as compared with white persons and that a large percentage of deaths have occurred in long-term care facilities. These findings are also consistent with existing racial disparities in the quality of nursing home care that persisted long before the present pandemic and which are also associated with source of payment (i.e., proportion of residents with Medicaid coverage). The “perfect storm” created by the pandemic has exacerbated existing inequities: high levels of segregation persist in nursing homes, nursing homes with higher proportions of non-white residents are associated with worse-quality care, and minority communities have experienced higher rates of COVID-19 infection due to several structural factors.

Health Care Workers

This article by Ebinger et al. reports on seroprevalence of SARS-CoV-2 antibodies among health care workers, using a large study population of both patient-facing and non-patient facing employees of a Los Angeles County health care delivery system. The study observed 4.1% seroprevalence overall and also found that seroprevalence was associated with Hispanic ethnicity and African-American race, even after adjusting for other factors, suggesting that structural and societal factors contributed to these differences (consistent with other research related to structural factors that contribute to racial disparities in COVID-19 infection). Seroprevalence was also associated with the presence of a personal or household member having prior medical diagnosis of COVID-19, highlighting the continued relevance of health care worker exposure through home and community settings in addition to patient care settings.