Pressure Injuries in Nursing Homes: Investigating Racial/Ethnic Differences Using National Data
Context: In the United States, Black nursing home (NH) residents have higher rates of pressure injury (PI) than White residents. Although some studies ascribe this to a relatively high proportion of Black residents in NHs with poor outcomes and limited resources, the factors that associate with PIs...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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LSE Press
2023-10-01
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| Series: | Journal of Long-Term Care |
| Subjects: | |
| Online Access: | https://account.journal.ilpnetwork.org/index.php/lse-j-jltc/article/view/185 |
| _version_ | 1797661507465510912 |
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| author | Lara Dhingra Clyde Schechter Stephanie DiFiglia Karen Lipson Russell Portenoy |
| author_facet | Lara Dhingra Clyde Schechter Stephanie DiFiglia Karen Lipson Russell Portenoy |
| author_sort | Lara Dhingra |
| collection | DOAJ |
| description |
Context: In the United States, Black nursing home (NH) residents have higher rates of pressure injury (PI) than White residents. Although some studies ascribe this to a relatively high proportion of Black residents in NHs with poor outcomes and limited resources, the factors that associate with PIs and their consequences across and within NHs remain poorly understood. Also, little is known about PIs among residents of differing races and ethnicities.
Objectives: Using four national datasets from 2016–2017, we evaluated U.S. NHs to characterize differences in PI-related outcomes among non-Hispanic Whites, non-Hispanic Blacks, Hispanics, Asians, American Indian or Alaska Natives, and Native Hawaiian or Other Pacific Islanders, and clarified the impact of resident-, facility-, and community-level characteristics on these outcomes.
Methods: We calculated the annual incidence rate of PIs, the probability of PI healing, and the prevalence of PI-associated pain and analgesic prescription. We determined the bivariate associations between each of these outcomes and race/ethnicity, and between each outcome and multiple potential covariates. Multivariable analyses then evaluated the associations between each outcome and race/ethnicity while adjusting for covariates.
Findings: In the bivariate analyses, the annual incidence rate of stage 2, 3, 4, and unstageable PIs for Whites was lower than Blacks and Hispanics, similar to American Indians or Alaska Natives, and higher than Asians and Native Hawaiians or Other Pacific Islanders. In the multivariable analyses, the PI incidence rate ratio was higher only among American Indians or Alaska Natives, and this difference was associated with a NH-level variable—the proportion of racial and ethnic minority residents. Other outcomes did not vary by race/ethnicity. An adjusted exploratory analysis was conducted to help explain the difference between the bivariate and multivariable analyses and revealed an important within-NH difference: Compared to Whites, the PI incidence rate ratios were higher in women who were Black, or American Indian or Alaska Native.
Limitations: Our findings are correlational and may be impacted by unevaluated variables and the limitations of administrative data.
Implications: In U.S. NHs, the annual incidence rate of PIs varies by race/ethnicity. Facility characteristics strongly influence this variation. Higher incidence rate ratios among racial and ethnic minority residents also are explained by differences within NHs and are striking among subgroups, including female residents who are Black, or American Indian or Alaska Native. Future research should evaluate the sexes separately and explore both across-NH and within-NH differences to determine whether there are structural inequities, bias, and disparate care.
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| first_indexed | 2024-03-11T18:46:33Z |
| format | Article |
| id | doaj.art-4e67183ea793490ea2c7f060defc61a8 |
| institution | Directory Open Access Journal |
| issn | 2516-9122 |
| language | English |
| last_indexed | 2024-03-11T18:46:33Z |
| publishDate | 2023-10-01 |
| publisher | LSE Press |
| record_format | Article |
| series | Journal of Long-Term Care |
| spelling | doaj.art-4e67183ea793490ea2c7f060defc61a82023-10-11T21:11:50ZengLSE PressJournal of Long-Term Care2516-91222023-10-0110.31389/jltc.185Pressure Injuries in Nursing Homes: Investigating Racial/Ethnic Differences Using National DataLara Dhingra0Clyde Schechter1Stephanie DiFiglia2Karen Lipson3Russell Portenoy4MJHS Institute for Innovation in Palliative Care; Department of Family and Social Medicine, Albert Einstein College of MedicineDepartment of Family and Social Medicine, Albert Einstein College of MedicineMJHS Institute for Innovation in Palliative CareLeadingAge New YorkMJHS Institute for Innovation in Palliative Care; Department of Neurology, Albert Einstein College of Medicine Context: In the United States, Black nursing home (NH) residents have higher rates of pressure injury (PI) than White residents. Although some studies ascribe this to a relatively high proportion of Black residents in NHs with poor outcomes and limited resources, the factors that associate with PIs and their consequences across and within NHs remain poorly understood. Also, little is known about PIs among residents of differing races and ethnicities. Objectives: Using four national datasets from 2016–2017, we evaluated U.S. NHs to characterize differences in PI-related outcomes among non-Hispanic Whites, non-Hispanic Blacks, Hispanics, Asians, American Indian or Alaska Natives, and Native Hawaiian or Other Pacific Islanders, and clarified the impact of resident-, facility-, and community-level characteristics on these outcomes. Methods: We calculated the annual incidence rate of PIs, the probability of PI healing, and the prevalence of PI-associated pain and analgesic prescription. We determined the bivariate associations between each of these outcomes and race/ethnicity, and between each outcome and multiple potential covariates. Multivariable analyses then evaluated the associations between each outcome and race/ethnicity while adjusting for covariates. Findings: In the bivariate analyses, the annual incidence rate of stage 2, 3, 4, and unstageable PIs for Whites was lower than Blacks and Hispanics, similar to American Indians or Alaska Natives, and higher than Asians and Native Hawaiians or Other Pacific Islanders. In the multivariable analyses, the PI incidence rate ratio was higher only among American Indians or Alaska Natives, and this difference was associated with a NH-level variable—the proportion of racial and ethnic minority residents. Other outcomes did not vary by race/ethnicity. An adjusted exploratory analysis was conducted to help explain the difference between the bivariate and multivariable analyses and revealed an important within-NH difference: Compared to Whites, the PI incidence rate ratios were higher in women who were Black, or American Indian or Alaska Native. Limitations: Our findings are correlational and may be impacted by unevaluated variables and the limitations of administrative data. Implications: In U.S. NHs, the annual incidence rate of PIs varies by race/ethnicity. Facility characteristics strongly influence this variation. Higher incidence rate ratios among racial and ethnic minority residents also are explained by differences within NHs and are striking among subgroups, including female residents who are Black, or American Indian or Alaska Native. Future research should evaluate the sexes separately and explore both across-NH and within-NH differences to determine whether there are structural inequities, bias, and disparate care. https://account.journal.ilpnetwork.org/index.php/lse-j-jltc/article/view/185health disparitiesMedicareaging in racial and ethnic minoritiespressure injuriesnursing homes |
| spellingShingle | Lara Dhingra Clyde Schechter Stephanie DiFiglia Karen Lipson Russell Portenoy Pressure Injuries in Nursing Homes: Investigating Racial/Ethnic Differences Using National Data Journal of Long-Term Care health disparities Medicare aging in racial and ethnic minorities pressure injuries nursing homes |
| title | Pressure Injuries in Nursing Homes: Investigating Racial/Ethnic Differences Using National Data |
| title_full | Pressure Injuries in Nursing Homes: Investigating Racial/Ethnic Differences Using National Data |
| title_fullStr | Pressure Injuries in Nursing Homes: Investigating Racial/Ethnic Differences Using National Data |
| title_full_unstemmed | Pressure Injuries in Nursing Homes: Investigating Racial/Ethnic Differences Using National Data |
| title_short | Pressure Injuries in Nursing Homes: Investigating Racial/Ethnic Differences Using National Data |
| title_sort | pressure injuries in nursing homes investigating racial ethnic differences using national data |
| topic | health disparities Medicare aging in racial and ethnic minorities pressure injuries nursing homes |
| url | https://account.journal.ilpnetwork.org/index.php/lse-j-jltc/article/view/185 |
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