Public health expert: COVID-19 pandemic highlighting health care disparities in U.S. system

The COVID-19 pandemic opened a Pandora’s box of inequalities in the U.S., highlighting the widespread disparities in health care and social injustice. Black and Hispanic communities have experienced a disproportionately large number of COVID-19 related deaths; this is especially true among nursing home residents.

Health policy researcher Amit Kumar, who recently co-authored an article that looks at COVID-19 mortality by race and ethnicity, is available to discuss the factors that contribute to these disparities. Kumar is an assistant professor at Northern Arizona University’s Phoenix Biomedical Campus who studies disparities in health care and risk adjustment when comorbidities, socioeconomic status and a patient’s functional status are taken into account.

The study, published in JAMDA, analyzes nursing home mortality rates from the Center for Medicare and Medicaid Services compared to county level data on mortality and deaths published in The New York Times; the researchers found nursing homes with a high proportion of Black and Hispanic residents had significantly higher COVID-19 mortality rates per 1,000 residents compared to homes with majority white residents.

Findings:

• During the initial period, the average death rate was 6.8 per 1,000 residents in home with a majority of Black residents and 4.0 per 1,000 residents in homes with a majority of Hispanic residents, compared to 3.3 deaths per 1,000 in nursing homes with high proportions of white residents.
• From mid-November on, the trend shifted and showed a spike in COVID-19 mortality in nursing homes with a higher proportion of white residents compared to nursing homes with majority residents of color.
• After November, the average death rate was 6.3 per 1,000 residents in nursing homes with a majority of white residents compared to 3.3 deaths per 1,000 in nursing homes with high proportions of Black and Hispanic residents.

Quotes:

• “Rural areas saw a stark increase in infection rates during the latter part of the fall of 2020. People living in rural areas tend to be older, white, have higher rates of underlying comorbidities and have limited access to health care infrastructures such as intensive care units and emergency medical services.”
• “While nursing home residents are in the top priority group for vaccine distribution in all states, vaccination rates among staff and Black residents have been low. Moving forward, as vaccination continues, policymakers need to evaluate vaccine distribution and inequities. The CMS has not updated vaccination data in their public file, which is critical to ensure that vaccine distribution addresses the nursing homes with high minority proportions.”
• “This is a long-understudied area; few initial studies have reported that almost 40 percent of COVID-19-related deaths happen in U.S nursing homes. Before the COVID-19 pandemic, there is also a long history of racial disparities in the quality of nursing home care and patient outcomes.”

Recommendations to improve equity in quality of care in nursing homes: 

• Payment: State Medicaid covers patient stays in long-term care. Medicaid payment rates are relatively low and vary by state, which leads to understaffing in nursing homes and poor salary structure nursing home staffs.
• Penalty: Current penalty system for nursing homes encourage disparity. Nursing homes treating sicker, minority and higher percentage of Medicaid patients have worse outcomes. Penalizing nursing homes on worse outcomes would exacerbate disparity. Instead, they need more support from state governments.