Deconstructing Racial Differences in Receipt of Secondary Stroke Prevention Agents in Nursing Homes

AbstractWe 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...