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Spatial and racial covid-19 disparities in U.S. nursing homes

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  • Wong, Sandy
  • Ponder, C.S.
  • Melix, Bertram

Abstract

In many parts of the world nursing home residents have experienced a disproportionate risk of exposure to COVID-19 and have died at much higher rates than other groups. There is a critical need to identify the factors driving COVID-19 risk in nursing homes to better understand and address the conditions contributing to their vulnerability during public health crises. This study investigates the characteristics associated with COVID-19 cases and deaths among residents in U.S. nursing homes from 2020 to 2021, with a focus on geospatial and racial inequalities. Using data from the Centers for Medicare and Medicaid Services and LTCFocus, this paper uses zero-inflated negative binomial regression models, Kruskal-Wallis tests, and Local Moran's I to generate statistical and geospatial results. Our analysis reveals that majority Hispanic facilities have alarmingly high COVID-19 cases and deaths, suggesting that these facilities have the greatest need for policy improvements in staffing and financing to reduce racial inequalities in nursing home care. At the same time we also detect COVID-19 hot spots in rural areas with predominately White residents, indicating a need to rethink public messaging strategies in these areas. The top states with COVID-19 hot spots are Kentucky, Pennsylvania, Illinois, and Oklahoma. This research provides new insights into the socio-spatial contexts and inequities that contribute to the vulnerability of nursing home residents during a pandemic.

Suggested Citation

  • Wong, Sandy & Ponder, C.S. & Melix, Bertram, 2023. "Spatial and racial covid-19 disparities in U.S. nursing homes," Social Science & Medicine, Elsevier, vol. 325(C).
    • Handle: RePEc:eee:socmed:v:325:y:2023:i:c:s0277953623002514
    DOI: 10.1016/j.socscimed.2023.115894
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    References listed on IDEAS

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    1. Skinner-Dorkenoo, Allison L. & Sarmal, Apoorva & Rogbeer, Kasheena G. & André, Chloe J. & Patel, Bhumi & Cha, Leah, 2022. "Highlighting COVID-19 racial disparities can reduce support for safety precautions among White U.S. residents," Social Science & Medicine, Elsevier, vol. 301(C).
    2. CS Ponder & Andrew Longhurst & Margaret McGregor, 2021. "Contracting-out care: The socio-spatial politics of nursing home care at the intersection of British Columbia’s labor, land, and capital markets," Environment and Planning C, , vol. 39(4), pages 800-817, June.
    3. Lee, Haena & Andrasfay, Theresa & Riley, Alicia & Wu, Qiao & Crimmins, Eileen, 2022. "Do social determinants of health explain racial/ethnic disparities in COVID-19 infection?," Social Science & Medicine, Elsevier, vol. 306(C).
    4. Amy Horton, 2022. "Financialization and non-disposable women: Real estate, debt and labour in UK care homes," Environment and Planning A, , vol. 54(1), pages 144-159, February.
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