# The impact of facility characteristics on racial disparities in ADRD mortality in nursing homes

> **NIH NIH F31** · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · 2022 · $38,551

## Abstract

PROJECT SUMMARY/ABSTRACT
This mentored Ruth L. Kirschstein National Research Service Award will provide the trainee, a PhD student in
epidemiology at UCSF, necessary training in social inequalities in nursing home (NH) care delivery,
determinants of mortality risk for older adults with Alzheimer’s disease and Alzheimer’s disease related
dementias (AD/ADRD), and quantitative skills for analyzing and accounting for bias in large administrative
datasets. Guided by a team of expert mentors, the trainee will gain the skills, practical experience, and
knowledge to launch a successful academic research career dedicated to the application of rigorous
epidemiologic methods to study the social systems of aging and health services in the context of ongoing
social inequity, health inequality, and institutional and structural racism.
The COVID-19 pandemic heightened the burden on NHs and increased variation in facility characteristics
including staffing ratios and average nurse hours per resident day. The resulting systemic stress can highlight
institutional drivers of long-standing health inequities among NH residents with AD/ADRD by race/ethnicity.
While large racial inequalities in excess mortality occurred during the COVID-19 pandemic, the determinants of
these inequalities—particularly among NH residents living with AD/ADRD—are not known. Prior studies of
excess mortality in NHs have not explored the effects of time-varying, policy-relevant variables like NH
occupancy and staffing characteristics. Building on prior work of the trainee, this F31 uses linked administrative
datasets including comprehensive mortality data for the state of California and NH facility data from the
Centers for Medicare and Medicaid Services to: (Aim 1) estimate pandemic-era excess mortality overall and
stratified by race/ethnicity among all NH residents, NH residents with AD/ADRD, and multimorbid NH residents
with AD/ADRD, and (Aim 2) identify time-invariant and time-varying facility/staffing characteristics linked to
excess mortality and racial disparities in excess mortality in these populations. This analysis will deliver policy-
relevant evidence on NH characteristics that put older adults at risk and fulfill the candidate’s training aims to
position her for ongoing research to improve the lives of Black and Latinx older adults with AD/ADRD living in
NHs. This proposal’s major strengths are: (1) a state-level census of mortality in California dating back to 2016;
(2) longitudinal census data of all NH facilities in California over the same period; and (3) innovative
hypotheses focusing on gaps in health equity research for highly vulnerable older adults. Knowledge gained
from this research will advance the NIA’s mission to identify and evaluate structural factors that produce
disparities in quality and access to care in old age. Guided by an exemplary mentorship team, the proposed
training will enhance the applicant’s methodological skills, research competency, and content ...

## Key facts

- **NIH application ID:** 10538328
- **Project number:** 1F31AG079651-01
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
- **Principal Investigator:** Michelle Anne DeVost
- **Activity code:** F31 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $38,551
- **Award type:** 1
- **Project period:** 2022-09-01 → 2024-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10538328

## Citation

> US National Institutes of Health, RePORTER application 10538328, The impact of facility characteristics on racial disparities in ADRD mortality in nursing homes (1F31AG079651-01). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10538328. Licensed CC0.

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