Healthcare News

African-Americans More Prone To Pressure Ulcers In Nursing Homes

March 16, 2017

Black residents of nursing homes at high risk of having pressure ulcers are more likely to develop them compared to other high risk residents, especially in homes where a large proportion of residents are African-Americans, researchers from the University of Iowa reported in JAMA (Journal of the American Medical Association).

The authors explained:

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

Yue Li, Ph.D., and team examined pressure ulcer rates in nursing homes in the USA by race and site of care, spanning from 2003 to 2008. They gathered data on 2.1 million Caucasian and 346,808 African-American residents in 12,473 nursing homes throughout the country. They were all considered to be at high risk of having pressure ulcers. They categorized the nursing homes according to percentage of African-American residents.

Although pressure ulcer prevalence dropped overall from 2003 to 2008 among high-risk individuals, throughout the whole period African-American residents had significantly higher rates than their Caucasian counterparts.

Pressure ulcer rates in US nursing homes: African-American residents in 2003 - 16.8% African-American residents in 2008 - 14.6% Caucasian residents in 2003 - 11.4% Caucasian residents in 2008 - 9.6% Although the rates dropped, the racial disparity remained pretty much the same.

Over half of the disparity between African-Americans and Caucasians was observed between nursing homes, rather than within them, the authors explained.

Below are some highlighted findings from this study: 15.5% of African-American residents in nursing homes with a high black resident percentage had pressure ulcers (the highest rate) in 2008. 8.8% of Caucasian residents in homes with the lowest concentrations of black residents had pressure ulcers (the lowest rate). Caucasian and African-American residents in homes with the highest concentrations of black residents both had a 30%+ higher risk of developing pressure ulcers compared to those in homes where the black concentration was low. Nursing homes with a high percentage of African-American residents were more likely to have fewer staff or registered nurses and certified nurse assistants. They also tended to belong for larger profit-making urban businesses.

The authors wrote:

"These facilities may be more financially disadvantaged when caring for patients predominantly receiving Medicaid.

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 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.

Importantly, future quality initiatives such as the renewed Centers for Medicare & Medicaid Services quality improvement organization program could consider incorporating disparity-eliminating efforts." Accompanying Editorial Nancy Bergstrom, Ph.D., R.N., Susan D. Horn, Ph.D. wrote that databases should include data on new or incident pressure ulcers, instead of merely the existence of a pressure ulcer. Otherwise, an individual who is admitted from a hospital who already has a pressure ulcers appears in the home's pressure ulcer statistics.

They wrote:

"Additional research is needed to accurately identify the causes of black and white differences in the incidence of pressure ulcers in nursing facilities. Individual characteristics, staffing, and system changes such as mattresses and disposable briefs can all affect pressure ulcer risk and rates and help explain disparities. Establishing the causative factors in pressure ulcer rates will be important to help to ensure that all nursing facility residents receive appropriate care."

"Association of Race and Sites of Care With Pressure Ulcers in High-Risk Nursing Home Residents"
Yue Li, PhD; Jun Yin, MS; Xueya Cai, PhD; Jna Temkin-Greener, PhD; Dana B. Mukamel, PhD
JAMA. 2011;306(2):179-186. doi: 10.1001/jama.2011.942