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Neither Race nor Ethnicity Impact the Mortality of Residents of Veterans Affairs Community Living Center with COVID-19

  • Mayyadah H. Alabdely
    Affiliations
    Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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  • Sonya Kothadia
    Affiliations
    Division of Infectious Diseases & HIV Medicine in the Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
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  • Taissa Bej
    Affiliations
    Geriatric Research Education and Clinical Center (GRECC), VA Northeast Ohio Healthcare System, Cleveland, Ohio
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  • Brigid M. Wilson
    Affiliations
    Division of Infectious Diseases & HIV Medicine in the Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio

    Geriatric Research Education and Clinical Center (GRECC), VA Northeast Ohio Healthcare System, Cleveland, Ohio
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  • Sunah Song
    Affiliations
    Cleveland Institute for Computational Biology at Case Western Reserve University School of Medicine, Cleveland, Ohio
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  • Ukwen Akpoji
    Affiliations
    Department of Pharmacy, VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA
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  • Corinne Kowal
    Affiliations
    Geriatric Research Education and Clinical Center (GRECC), VA Northeast Ohio Healthcare System, Cleveland, Ohio
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  • Federico Perez
    Affiliations
    Division of Infectious Diseases & HIV Medicine in the Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio

    Geriatric Research Education and Clinical Center (GRECC), VA Northeast Ohio Healthcare System, Cleveland, Ohio
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  • Author Footnotes
    ∗ Currently at the GRECC, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania and the Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
    Robin L.P. Jump
    Correspondence
    Corresponding Author: Robin L. P. Jump M.D., Ph.D., VA Pittsburgh Health Care System, Geriatric Research, Education and Clinical Center (OOGR-U), University Drive, Pittsburgh, PA 15240, USA; Telephone: 412-360-2916; Fax: 412-360-4922;
    Footnotes
    ∗ Currently at the GRECC, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania and the Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
    Affiliations
    Division of Infectious Diseases & HIV Medicine in the Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio

    Geriatric Research Education and Clinical Center (GRECC), VA Northeast Ohio Healthcare System, Cleveland, Ohio
    Search for articles by this author
  • Author Footnotes
    ∗ Currently at the GRECC, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania and the Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
Published:November 03, 2022DOI:https://doi.org/10.1016/j.jamda.2022.10.020
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      Abstract

      Objectives

      COVID-19 disproportionately affected nursing home residents and people from racial and ethnic minorities in the US. Nursing homes in the Veterans Affairs (VA) system, termed Community Living Centers (CLCs), belong to a national managed care system. In the period prior to the availability of vaccines, we examined whether residents from racial and ethnic minorities experienced disparities in COVID-19 related mortality.

      Design

      Retrospective cohort study.

      Setting and Participants

      Residents at 134 VA CLCs from April 14 to December 10, 2020

      Methods

      We used the VA’s Corporate Data Warehouse to identify VA CLC residents with a positive SARS-CoV-2 PCR test during or 2 days prior to their admission and without a prior case of COVID-19. We assessed age, self-reported race/ethnicity, frailty, chronic medical conditions, Charlson comorbidity index, the annual quarter of the infection, and all-cause 30-day mortality. We estimated odds ratios (OR) and 95% confidence intervals (CIs) of all-cause 30-day mortality using a mixed-effects multivariable logistic regression model.

      Results

      During the study period, 1133 CLC residents had an index positive SARS-CoV-2 test. Mortality at 30 days was 23% for White non-Hispanic residents, 15% for Black non-Hispanic residents, 10% for Hispanic residents, and 16% for other residents. Factors associated with increased 30-day mortality were age ≥70, Charlson comorbidity index ≥6, and a positive SARS-CoV-2 test between April 14 and June 30, 2020. Frailty, Black race, and Hispanic ethnicity were not independently associated with an increased risk of 30-day mortality.

      Conclusions and Implications

      Among a national cohort of VA CLC residents with COVID-19, neither Black race nor Hispanic ethnicity had a negative impact on survival. Further research is needed to determine factors within the VA healthcare system that mitigate the influence of systemic racism on COVID-19 outcomes in US nursing homes.

      Keywords