Black/White differences in pressure ulcer incidence in nursing home residents.
OBJECTIVE
To compare black and white nursing home residents with respect to the incidence of nursing home (NH)-acquired pressure ulcers (PUs) and to examine the role of resident characteristics and facility characteristics in explaining differences between the racial groups.


METHODS
Prospective cohort study conducted between 1992 and 1995.


METHODS
Fifty-nine Maryland NHs.


METHODS
A total of 1,938 residents (301 black, 1,637 white) aged 65 and older newly admitted to participating NHs.


METHODS
The outcome variable was the first occurrence of a Stage 2, 3, or 4 PU as determined based on medical record review. The predictor variable was race (black, white). Eight resident characteristics (age, sex, number of activity of daily living dependencies, bedfast, PU on admission to facility, incontinence, dementia, and whether the resident was on Medicaid) and three facility characteristics (number of beds, for-profit ownership status, and urban/nonurban location) were considered as possible confounding variables.


RESULTS
The incidence of PUs was 0.38 per person-year in the NH. The rate for blacks was significantly higher than for whites (0.56 vs 0.35 per person-year) (P<.001). In multivariate analysis, controlling for eight resident characteristics and three facility characteristics, race was significantly associated with PU incidence (hazard ratio comparing blacks with whites=1.31, 95% confidence interval=1.02-1.66).


CONCLUSIONS
Blacks have a higher incidence of NH-acquired PUs than whites; resident characteristics appear to mediate the higher risk. Future research should aim to identify modifiable factors that explain differences between racial groups in PU risk and to develop solutions to prevent the suffering and cost associated with PUs.
Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore, Maryland 21201, USA. mbaumgar@epi.umaryland.edu
Mona
M
Baumgarten
David
D
Margolis
Carol
C
van Doorn
Ann L
AL
Gruber-Baldini
J Richard
JR
Hebel
Sheryl
S
Zimmerman
Jay
J
Magaziner
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008396:Maryland / Q000453:epidemiology; D009735:Nursing Homes; D003668:Pressure Ulcer / Q000453:epidemiology*; D011446:Prospective Studies; D044465:White People; D001741:Black or African American