Prevalence of pressure ulcers among black high-risk nursing home residents related to site of care

July 12, 2011

Among nursing home residents at high risk for pressure ulcers, black residents had higher prevalence rates than white residents from 2003 through 2008, with the disparity largely related to the higher rates among nursing homes that disproportionately serve black residents, according to a study in the July 13 issue of JAMA.

"Pressure ulcers are a common health problem among nursing and substantially increase morbidity, mortality, and the cost of care," the authors write. "A variety of nursing home quality improvement programs have been implemented during the last decade but their implications for on quality are unknown."

Yue Li, Ph.D., of the University of Iowa, Iowa City, and colleagues analyzed the trend of pressure ulcer prevalence in by race and site of care from 2003 through 2008. The study included data on pressure ulcer rates in 2.1 million white and 346,808 black residents of 12,473 certified nursing homes in the United States who were considered at of developing pressure ulcers. Nursing homes were categorized according to their proportions of black residents.

The researchers found that pressure ulcer rates decreased overall from 2003 through 2008 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 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 write.

"Given the widespread racial disparities in nursing home care, it is imperative to close the gap beyond industry-wide improvements. 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 is concentrated among a small number of nursing homes, understanding how outcomes vary as a function of site of care can inform targeted interventions," the researchers write.

The authors add that their findings suggest several policy implications. "Importantly, future quality initiatives such as the renewed Centers for Medicare & Medicaid Services quality improvement organization program could consider incorporating disparity-eliminating efforts."

Explore further: New disparity in nursing homes: Whites leave, minorities enter

More information: JAMA. 2011;306[2]179-186.

Related Stories

New disparity in nursing homes: Whites leave, minorities enter

July 7, 2011
In the last decade, minorities have poured into nursing homes at a time when whites have left in even greater numbers, according to a new Brown University study that suggests a racial disparity in elder care options in the ...

Recommended for you

High-fat diet in pregnancy can cause mental health problems in offspring

July 21, 2017
A high-fat diet not only creates health problems for expectant mothers, but new research in an animal model suggests it alters the development of the brain and endocrine system of their offspring and has a long-term impact ...

To combat teen smoking, health experts recommend R ratings for movies that depict tobacco use

July 21, 2017
Public health experts have an unusual suggestion for reducing teen smoking: Give just about any movie that depicts tobacco use an automatic R rating.

Opioids and obesity, not 'despair deaths,' raising mortality rates for white Americans

July 20, 2017
Drug-related deaths among middle-aged white men increased more than 25-fold between 1980 and 2014, with the bulk of that spike occurring since the mid-1990s when addictive prescription opioids became broadly available, according ...

Aging Americans enjoy longer life, better health when avoiding three risky behaviors

July 20, 2017
We've heard it before from our doctors and other health experts: Keep your weight down, don't smoke and cut back on the alcohol if you want to live longer.

Parents have critical role in preventing teen drinking

July 20, 2017
Fewer teenagers are drinking alcohol but more needs to be done to curb the drinking habits of Australian school students, based on the findings of the latest study by Adelaide researchers.

Fresh fish oil lowers diabetes risk in rat offspring

July 19, 2017
Fresh fish oil given to overweight pregnant rats prevented their offspring from developing a major diabetes risk factor, Auckland researchers have found.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.