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Purpose: To assess racial/ethnic disparities in time to development of any type of incontinence in individuals aged 65+ years after NH admissions, using multi-level factors.
Methods: We analyzed 2000-2002 Minimum Data Set data (resident health) and Online Survey, Certification, and Reporting data (NH staffing, population characteristics, and care deficiencies) and 2000 Census data (socioeconomic status surrounding NHs). Residents (n=90,500) were free of incontinence at admission to one of 446 proprietary NHs located in 27 states, 66% female, aged 82(8) years (mean(SD)), 88% White, 8% Black, 2% Hispanic, and 1% Asian. Clinically relevant predictors of time to incontinence were first analyzed in a Cox proportional hazards regression for Whites, controlling for effects of individual NHs. To assess disparities, we used the Peters-Belson method: estimates from the Cox model were applied to minority groups separately resulting in estimates of their expected times to incontinence, as if they were White, then compared to their actual times to incontinence. To assess any differential effect of the predictors by race in significant disparities, a second Cox regression analyzed interactions of race with predictors of incontinence.
Results: Actual and expected time to develop incontinence did not differ significantly in Blacks and Hispanics; in Asians, incontinence incidence was lower than expected (p<.001). Specifically, the proportions of minorities expected to be free vs. actually free of incontinence at 6 and 12 months after admission were Blacks=.67 and .49 (expected) vs. .63 and .47 (actual); Hispanics=.66 and .50 vs. 67 and .52; Asians=.52 and .34 vs. 64 and .40. No predictors of the lesser incidence in Asians were significant.
Conclusions: Incontinence in NHs is a multi-factorial problem. When considering NH and resident factors, there is little evidence of disparities.