Abstract
We sought to evaluate empirically the notion that previously observed racial differences in secondary prevention of stroke relate to the characteristics of nursing homes in which people of color reside.
We identified 18,577 people recently hospitalized with a primary discharge diagnosis of ischemic stroke in 6 states from 1992 to 1996, of which 6,910 residents living in 689 homes had concomitant conditions indicating anticoagulant therapy. Facility factors evaluated included structural (e.g., size), resources (e.g., staffing), and financial (e.g., for profit). Generalized linear models provided estimates of the effect of facility factors on receipt of warfarin adjusted by potential confounders.
Residents classified as black, not of Hispanic origin, were less likely than residents classified as non-Hispanic white to receive warfarin. For profit homes (vs. non-profit) were least likely to provide residents warfarin (resident and facility factor adjusted OR: 0.81; 95% CI: 0.70-0.94). Residing in a home with full-time physicians or non-profit homes attenuated racial differences in warfarin use, while racial differences in warfarin use were greater in for-profit settings. With increasing percentage of residents classified as non-Hispanic white, warfarin use declined across levels of race/ethnicity, although to a greater degree among residents who were classified as black, not of Hispanic origin.
Our study extends the understanding of the effect of race/ethnicity within the context of facility characteristics. Our data provide suggestions on how we might optimize drug therapy and eliminate racial differences by considering the necessity of supporting structures and resources in nursing homes.