A new study shows that among nursing home residents at high risk for pressure ulcers, black residents had higher prevalence rates than white residents with the disparity largely related to the higher rates among nursing homes that disproportionately serve blacks.
The study, reported in the July 13 issue of JAMA, analyzed the trend of pressure ulcer prevalence in nursing homes by race and site of care from 2003 through 2008. The researchers found that pressure ulcer rates decreased overall during that time among high-risk residents of nursing homes, but black residents showed persistently higher pressure ulcer rates than white residents. The pressure ulcer rate among black residents decreased from 16.8 percent in 2003 to 14.6 percent in 2008 and the rate among white residents decreased from 11.4 percent in 2003 to 9.6 percent in 2008. Despite the lowered pressure ulcer rates over time for both races, racial disparity remained relatively unchanged.
Analysis indicated that more than half of the risk-adjusted disparity between black and white residents in pressure ulcer rates for each year was found between sites rather than within sites of care. Black residents in the nursing home facilities with the highest concentrations of black residents had the highest pressure ulcer rate (15.5 percent in 2008), which was about 7 percent higher than the rate for white residents in facilities with lowest concentrations of black residents (8.8 percent in 2008), which was the lowest among all groups.
Residents of both races and in nursing homes with the highest concentrations of blacks had at least a 30 percent increased risk-adjusted odds of pressure ulcers compared with residents in nursing homes caring for none or only a small percentage of black residents. Nursing home facilities with higher concentrations of black residents had higher rates of pressure ulcers for both black and white residents compared with nursing homes with lower concentrations of black residents.
Nursing homes with higher concentrations of black residents tended to have lower staffing levels of registered nurses and certified nurse assistants and to be larger for-profit and urban facilities. "These facilities may be more financially disadvantaged when caring for patients predominantly receiving Medicaid," the authors said.
"Given the widespread racial disparities in nursing home care, it is imperative to close the gap beyond industry-wide improvements,” the researchers said. “The first key step would be understanding why these disparities exist before appropriate efforts can be made to eliminate them. Given that nursing home care for minority residents is concentrated among a small number of nursing homes, understanding how outcomes vary as a function of site of care can inform targeted interventions.”