title: Pressure ulcer prevalence among black and white nursing home residents in New York state: evidence of racial disparity?
abstract: OBJECTIVE
  The occurrence of pressure ulcers (PUs) in nursing homes is a marker for poor quality of care. We examine whether differences in PU prevalence between black and white residents are due to within- or across-facility disparities.
  
  
  METHODS
  Minimum Data Sets (2006-2007) are linked with the Online Survey Certification and Reporting database. Long-term care residents with high risk for PUs are identified. The dependent variable is dichotomous, indicating PU presence/absence. Individual race and facility race-mix are the main variables of interests.The sample includes 59,740 long-term care high-risk residents (17.4% black and 82.6% white) in 619 nursing homes. We fit 3 risk-adjusted logit models: base, conditional fixed-effects, and random-effects.
  
  
  RESULTS
  Unadjusted PU prevalence is 14.5% (18.2% for blacks and 13.8% for whites). Overall, blacks are more likely to have PUs than whites, controlling for individual risk factors. We find no such effect within facilities after additional accounting for facility fixed effects. The effect of race is significantly different between the base and the conditional fixed-effects logit model. The random-effects and conditional fixed-effects logit models show similar results, demonstrating that higher PU presence among blacks is associated with greater facility-specific concentration of black residents.
  
  
  CONCLUSIONS
  Greater PU occurrence among blacks may not result from differential within-facility treatment of blacks versus whites. Rather, blacks are more likely to reside in facilities with poorer care quality. To improve PU care for blacks, efforts should focus on improving the overall quality of care for facilities with high proportion of black residents.
authors.affiliation: Center for Gerontology and Health Care Research, The Warren Alpert Medical School, Brown University, 121 South Main Street, Providence, RI 02912, USA. Shubing_Cai@brown.edu.edu
authors.forename: Shubing
authors.initials: S
authors.lastname: Cai
authors.forename: Dana B
authors.initials: DB
authors.lastname: Mukamel
authors.forename: Helena
authors.initials: H
authors.lastname: Temkin-Greener
mesh_terms: D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D001509:Bed Occupancy / Q000706:statistics & numerical data; D014487:Centers for Medicare and Medicaid Services, U.S. / Q000706:statistics & numerical data; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006707:Homes for the Aged / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009518:New York / Q000453:epidemiology; D009735:Nursing Homes / Q000706:statistics & numerical data; D009740:Nursing Staff / Q000706:statistics & numerical data; D010561:Personnel Staffing and Scheduling / Q000706:statistics & numerical data; D003668:Pressure Ulcer / Q000208:ethnology*; D015995:Prevalence; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012307:Risk Factors; D012959:Socioeconomic Factors; D014481:United States; D044465:White People