Table 3.
Association between select nursing home resident, facility, and hospital referral region (HRR) characteristics and high intensity statin use by age
| Characteristics | 65–75 years-old | ≥76 years-old | ||||||
|---|---|---|---|---|---|---|---|---|
| No.a | Row % on statins | ORb | aOR (95% CI)c | No.a | Row % on statins | ORb | aOR (95% CI)c | |
| Overall | 77,819 | 11.4 | - | - | 283,351 | 5.3 | - | - |
| Resident- level | ||||||||
| Atherosclerotic Cardiovascular Disease (ASCVD) risk | ||||||||
| ASCVD diagnosis | 27,924 | 15.1 | * | *referent | 79,942 | 7.7 | * | *referent |
| ≥1 risk factor for ASCVD | 43,267 | 10.4 | 0.64 | 0.64 (0.61–0.67) | 176,488 | 5.0 | 0.62 | 0.64 (0.62–0.66) |
| No risk factors for ASCVD | 6,628 | 1.9 | 0.11 | 0.12 (0.10–0.14) | 26,921 | 0.9 | 0.11 | 0.12 (0.11–0.14) |
| Facility- level | ||||||||
| Ownership | ||||||||
| For-profit | 61,866 | 11.4 | * | *referent | 194,671 | 5.4 | * | *referent |
| Government | 10,544 | 11.8 | 1.01 | 1.03 (0.96–1.10) | 66,431 | 5.1 | 0.96 | 1.02 (0.98–1.07) |
| Non-profit | 5,399 | 10.4 | 0.88 | 0.94 (0.84–1.04) | 22,249 | 5.2 | 0.98 | 1.01 (0.94–1.09) |
| Facility size (no. beds) | ||||||||
| <50 | 1,913 | 11.6 | 1.00 | 1.02 (0.86–1.21) | 10,770 | 4.4 | 0.81 | 0.91 (0.81–1.02) |
| 50–100 | 19,940 | 11.5 | 1.02 | 0.98 (0.89–1.07) | 79,363 | 5.3 | 0.97 | 1.01 (0.95–1.08) |
| 100–200 | 44,640 | 11.4 | 1.01 | 0.97 (0.90–1.04) | 155,387 | 5.4 | 0.98 | 0.99 (0.94–1.05) |
| >200 | 11,326 | 10.9 | * | *referent | 37,831 | 5.3 | * | *referent |
| Occupancy | ||||||||
| <80% | 24,481 | 11.3 | 1.00 | 0.99 (0.92–1.06) | 77,127 | 5.4 | 1.08 | 1.06 (1.00–1.12) |
| 80 to <90% | 23,515 | 11.5 | 1.02 | 0.99 (0.92–1.06) | 85,795 | 5.3 | 1.03 | 1.02 (0.97–1.07) |
| 90 to <95% | 16,655 | 11.3 | 1.00 | 0.98 (0.91–1.06) | 65,738 | 5.3 | 1.01 | 1.00 (0.95–1.06) |
| ≥95% | 13,168 | 11.2 | * | *referent | 54,691 | 5.2 | * | *referent |
| % Black/African American residents | ||||||||
| 0 to <15% | 48,644 | 11.2 | * | *referent | 215,795 | 5.1 | * | *referent |
| 15 to <50% | 22,030 | 11.4 | 1.05 | 1.06 (0.99–1.12) | 53,828 | 5.9 | 1.17 | 1.13 (1.07–1.19) |
| ≥50% | 7,145 | 12.3 | 1.12 | 1.12 (1.01–1.23) | 13,728 | 7.0 | 1.38 | 1.28 (1.17–1.39) |
| Overall Nursing Home Compare Star rating | ||||||||
| 1 | 18,305 | 10.8 | * | *referent | 48,958 | 5.5 | * | *referent |
| 2 | 16,886 | 11.7 | 1.10 | 1.07 (1.00–1.14) | 53,011 | 5.5 | 1.00 | 1.00 (0.95–1.06) |
| 3 | 15,213 | 11.7 | 1.10 | 1.08 (1.00–1.16) | 54,409 | 5.2 | 0.95 | 0.97 (0.92–1.03) |
| 4 | 15,882 | 11.1 | 1.04 | 1.02 (0.95–1.10) | 67,862 | 5.4 | 0.98 | 1.01 (0.95–1.07) |
| 5 | 11,533 | 11.5 | 1.09 | 1.07 (0.98–1.17) | 59,111 | 5.1 | 0.92 | 0.97 (0.91–1.04) |
| Regional- level | ||||||||
| Rural location | 19,399 | 11.3 | 0.97 | 0.99 (0.93–1.05) | 77,141 | 5.1 | 0.99 | 0.98 (0.94–1.03) |
| US census region | ||||||||
| Northeast | 15,666 | 11.4 | * | *referent | 68,013 | 5.5 | * | *referent |
| Midwest | 19,462 | 12.1 | 1.03 | 0.98 (0.83–1.15) | 79,861 | 5.2 | 0.82 | 0.73 (0.60–0.89) |
| South | 33,767 | 11.0 | 0.94 | 0.83 (0.72–0.97) | 107,731 | 5.3 | 0.91 | 0.75 (0.62–0.90) |
| West | 8,924 | 11.0 | 0.94 | 0.97 (0.81–1.17) | 27,746 | 5.1 | 0.77 | 0.78 (0.62–0.97) |
| Hospital days per decedent | ||||||||
| Q1 | 11,366 | 11.8 | * | *referent | 47,800 | 4.7 | * | *referent |
| Q2 | 17,569 | 11.8 | 1.00 | 0.96 (0.86–1.07) | 64,071 | 5.3 | 1.11 | 1.07 (0.96–1.20) |
| Q3 | 22,734 | 11.0 | 0.94 | 0.89 (0.80–0.99) | 76,604 | 5.4 | 1.13 | 1.06 (0.95–1.19) |
| Q4 | 26,150 | 11.2 | 1.01 | 0.93 (0.83–1.05) | 94,876 | 5.6 | 1.25 | 1.14 (1.01–1.29) |
| % deaths occurring in the hospital | ||||||||
| Q1 | 15,807 | 11.6 | * | *referent | 58,662 | 5.3 | * | *referent |
| Q2 | 21,318 | 11.3 | 1.01 | 0.99 (0.90–1.10) | 77,346 | 5.2 | 1.05 | 1.02 (0.92–1.14) |
| Q3 | 20,658 | 11.3 | 0.99 | 0.97 (0.87–1.07) | 71,356 | 5.4 | 1.11 | 1.07 (0.97–1.20) |
| Q4 | 20,036 | 11.2 | 1.00 | 0.98 (0.87–1.10) | 75,987 | 5.5 | 1.18 | 1.16 (1.03–1.31) |
| % deaths with included time in intensive care unit | ||||||||
| Q1 | 12,250 | 12.0 | * | *referent | 50,129 | 4.8 | * | *referent |
| Q2 | 18,091 | 11.7 | 1.00 | 0.97 (0.88–1.07) | 66,904 | 5.3 | 1.12 | 1.09 (0.98–1.21) |
| Q3 | 25,493 | 11.4 | 0.95 | 0.93 (0.84–1.02) | 90,793 | 5.5 | 1.16 | 1.12 (1.01–1.24) |
| Q4 | 21,985 | 10.7 | 0.92 | 0.87 (0.78–0.98) | 75,525 | 5.4 | 1.23 | 1.15 (1.02–1.29) |
| Intensive care days per decedent | ||||||||
| Q1 | 12,729 | 11.9 | * | *referent | 54,038 | 4.7 | * | *referent |
| Q2 | 21,646 | 11.4 | 0.94 | 0.91 (0.82–1.01) | 82,276 | 5.4 | 1.09 | 1.05 (0.95–1.17) |
| Q3 | 23,432 | 11.2 | 0.97 | 0.93 (0.84–1.03) | 78,376 | 5.4 | 1.16 | 1.09 (0.97–1.21) |
| Q4 | 20,012 | 11.0 | 0.92 | 0.87 (0.78–0.98) | 68,661 | 5.7 | 1.21 | 1.12 (1.00–1.26) |
| SNF days per decedent | ||||||||
| Q1 | 10,046 | 12.0 | * | *referent | 37,678 | 4.8 | * | *referent |
| Q2 | 16,640 | 11.4 | 0.96 | 0.94 (0.85–1.05) | 58,059 | 5.0 | 1.01 | 0.96 (0.86–1.07) |
| Q3 | 24,107 | 11.1 | 0.94 | 0.91 (0.81–1.01) | 86,467 | 5.4 | 1.06 | 1.01 (0.90–1.13) |
| Q4 | 27,026 | 11.3 | 0.97 | 0.93 (0.83–1.04) | 101,147 | 5.6 | 1.14 | 1.05 (0.93–1.18) |
| % enrolled in hospice | ||||||||
| Q1 | 18,787 | 11.0 | * | *referent | 74,465 | 5.2 | * | *referent |
| Q2 | 21,209 | 11.5 | 0.96 | 0.95 (0.86–1.05) | 79,719 | 5.3 | 0.95 | 0.92 (0.83–1.02) |
| Q3 | 19,423 | 11.2 | 1.00 | 0.98 (0.88–1.10) | 67,191 | 5.3 | 0.99 | 0.95 (0.85–1.06) |
| Q4 | 18,400 | 11.7 | 1.05 | 1.02 (0.90–1.15) | 61,976 | 5.6 | 0.99 | 0.95 (0.84–1.07) |
| Total physician visits per decedent | ||||||||
| Q1 | 10,010 | 12.3 | * | *referent | 42,755 | 4.6 | * | *referent |
| Q2 | 19,031 | 11.5 | 0.92 | 0.88 (0.79–0.98) | 71,339 | 5.2 | 1.06 | 1.00 (0.89–1.12) |
| Q3 | 23,380 | 11.5 | 0.92 | 0.86 (0.77–0.96) | 81,802 | 5.6 | 1.14 | 1.02 (0.91–1.15) |
| Q4 | 25,398 | 10.7 | 0.91 | 0.83 (0.74–0.94) | 87,455 | 5.5 | 1.17 | 1.04 (0.92–1.17) |
| % of patients seeing ≥10 different physicians | ||||||||
| Q1 | 11,078 | 11.7 | * | *referent | 46,678 | 4.6 | * | *referent |
| Q2 | 16,222 | 11.3 | 0.98 | 0.93 (0.84–1.04) | 56,632 | 5.2 | 1.09 | 1.04 (0.93–1.16) |
| Q3 | 21,672 | 11.3 | 0.97 | 0.91 (0.82–1.02) | 74,699 | 5.4 | 1.15 | 1.07 (0.95–1.20) |
| Q4 | 28,847 | 11.3 | 1.00 | 0.93 (0.82–1.04) | 105,342 | 5.6 | 1.20 | 1.08 (0.95–1.22) |
| Ratio of medical specialty to primary care | ||||||||
| Q1 | 13,333 | 11.2 | * | *referent | 53,702 | 4.8 | * | *referent |
| Q2 | 18,795 | 11.3 | 1.05 | 1.05 (0.95–1.16) | 65,442 | 5.1 | 1.04 | 1.01 (0.91–1.12) |
| Q3 | 21,399 | 11.7 | 1.05 | 1.04 (0.94–1.25) | 77,864 | 5.4 | 1.03 | 0.98 (0.89–1.09) |
| Q4 | 24,292 | 11.1 | 1.04 | 1.02 (0.91–1.13) | 86,343 | 5.8 | 1.18 | 1.11 (1.00–1.24) |
a
No. = number of residents with each characteristic in the sample- serves as a denominator for the row %, indicating the % of residents on statin pharmacotherapy;
b
OR = crude odds ratio;
c
aOR (95% CI) = adjusted odds ratio (95% Confidence Interval). All odds ratios were estimated via cross-classified multilevel logistic models with random intercepts for state and HRR. For resident-level and facility-level variables, adjusted odds ratios are derived from models that include adjustments for all resident-level and facility-level variables included in Supplemental Table 5 and the rural/urban indicator variable. For HRR-level variables, adjusted odds ratios are derived from separate models for each HRR-level variable that include all the resident- and facility- level variables adjusted for previously.