Term of Award

Fall 2021

Degree Name

Doctor of Public Health (Dr.P.H.)

Document Type and Release Option

Dissertation (open access)

Copyright Statement / License for Reuse

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


Jiann-Ping Hsu College of Public Health

Committee Chair

Samuel Opoku

Committee Member 1

Bettye Apenteng

Committee Member 2

William Mase


Objective: The COVID-19 pandemic disproportionately affected older populations, with nursing homes impacted early on by the disease. The contribution of race/ethnicity of nursing home residents and facility characteristics on COVID-19 were unknown. The Donabedian model framework was used to study the relationship between the racial/ethnic characteristics of nursing home residents and COVID-19 outcomes and to examine if this relationship was moderated by the racial/ethnic composition of the county of nursing home location.

Method: Cross-sectional research design merging data from five publicly available sources. Laboratory confirmed COVID-19 cases and deaths were compared by the racial composition of the county and nursing home. Firth logistic regression model and two zero-inflated negative binomial regression models were run to address the study aims. Statistical significance was assessed at p

Results: 14,405 nursing homes examined this study. These facilities reported a mean confirmed COVID-19 cases and deaths of 45 and 8, respectively. The interaction of nursing home location and resident racial composition was associated with the number of nursing home COVID-19 deaths.

Conclusion: Location characteristics of nursing homes in conjunction with a predominantly minority nursing home resident population did not play a role in the number of COVID-19 cases but did impact COVID-19 deaths. Standardized safety measures implemented in nursing homes seemed to help minimize differences in COVID-19 cases between nursing facilities. Historical health inequality for minority populations and social determinants of health are factors that could have increased the number of deaths for minority residents.

Research Data and Supplementary Material