Factors Associated With Mortality in Appalachian Nursing Homes During the COVID-19 Pandemic

INTRODUCTION: Disasters, including the recent COVID-19 pandemic, have disproportionately impacted nursing homes (NHs). NH residents experienced higher mortality during the pandemic, but not all NH were affected equally. Appalachia has a history of reduced health compared to the general United States. Therefore, this study is focused on NHs in Appalachia during the COVID-19 pandemic. PURPOSE: This study aimed to investigate how the neighborhood and NH characteristics are associated with mortality in Appalachian NHs during the COVID-19 pandemic. METHODS: Using publicly available datasets, including NH, patient, and county-level characteristics, the authors' investigated how the these factors impacted COVID-19 death, COVID-19 death rate, and total NH deaths by adopting negative binomial regression outcomes and multiple linear regression models. RESULTS: A total of 1259 NHs in Appalachia were included in the analysis. Deaths from COVID-19 were positively associated with the number of NH beds, share of White residents, and resident age. Centers for Medicare & Medicaid Services 5-star quality rating was negatively associated with COVID-19 deaths. On the other hand, although number of beds, acuity index, share of White residents, average age, and share of White residents in the community were positively associated with total deaths, lower county education levels and county income were negatively associated with total deaths. DISCUSSION AND IMPLICATIONS: NH and county characteristics associated with NH deaths varied from prior literature that included the general United States. Policymakers and NH leaders responsible for NHs in Appalachia should be sensitive to regional differences when making decisions and resource allocations.