Exacerbation of racial disparities in COVID-19 outcomes by Alzheimer's disease and related dementias among nursing home residents.

The COVID-19 pandemic has disproportionately impacted Black nursing home (NH) residents. Alzheimer's disease and related dementias (ADRDs) may exacerbate disparities, but little empirical evidence exists on the degree to which race and ADRDs intersect to impact COVID-19-related outcomes. We conducted a cohort study (April-December 2020) leveraging electronic health records from 12 US NH corporations. We used the parametric g-formula to obtain standardized estimates of incident COVID-19 infection and 30-day COVID-19-associated hospitalization or death by race, both overall and within strata of ADRD status. The cohort comprised 127 913 resident-episodes, including 15 379 incident COVID-19 infections, 1522 deaths, and 2548 hospitalizations. Black residents were more likely than White residents to experience incident COVID-19 and subsequent hospitalization, but not more likely to subsequently die. Disparities in hospitalization and a combined endpoint of hospitalization or death were more pronounced among residents with ADRDs compared to residents without ADRDs. These results suggest the presence of disparities in COVID-19 outcomes by race and provide evidence that ADRD status may exacerbate racial disparities in COVID-19 outcomes among nursing home residents. Our findings offer valuable insights for current and future preparedness efforts in NHs in the United States and countries with similarly underresourced long-term care settings. This article is part of a Special Collection on Methods in Social Epidemiology.