COVID-19 Pandemic and Racial and Ethnic Disparities in Long-Term Nursing Home Stay or Death Following Hospital Discharge

Abstract

IMPORTANCE: Long-term nursing home stay or death (long-term NH stay or death), defined as new long-term residence in a nursing home or death following hospital discharge, is an important patient-centered outcome. OBJECTIVE: To examine whether the COVID-19 pandemic was associated with changes in long-term NH stay or death among older adults with sepsis, and whether these changes were greater in individuals from racial and ethnic minoritized groups. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used patient-level data from the Medicare Provider Analysis and Review File, the Master Beneficiary Summary File, and the Minimum Data Set. Community-dwelling individuals aged at least 65 years hospitalized with sepsis between January 2016 and June 2021 were included. Data were analyzed from May to November 2024. EXPOSURE: Race and ethnicity and the COVID-19 pandemic. MAIN OUTCOMES AND MEASURES: Patients discharged alive experienced long-term NH stay or death if they resided in a nursing home more than 100 days after hospital discharge and had no period at home greater than 30 days, or died more than 30 days following hospital discharge. Interrupted time series analysis was used to evaluate the association between long-term NH stay or death and the pandemic and race and ethnicity. RESULTS: A total of 2964517 hospitalizations for sepsis of community-dwelling patients discharged alive (1468754 [49.5%] female; 19549 [0.7%] American Indian or Alaska Native, 95308 [3.2%] Asian or Pacific Islander, 282646 [9.5%] Black, 279011 [9.4%] Hispanic, 2288003 [71.2%] White individuals; mean [SD] age, 76 [8.3] years) were included. Compared with non-Hispanic White individuals, Black individuals were more likely to experience long-term NH stay or death (adjusted odds ratio [aOR], 1.33; 95% CI, 1.30-1.37; P