Atrial fibrillation (AF) is prevalent in long‐term care (LTC) facilities. Real‐world data demonstrate that Black patients with AF are 10% to 22% less likely to be on anticoagulation compared with White patients in the ambulatory setting. It is unclear if this disparity is present in the LTC setting as well.

LTC care is highly segregated. Compared with White residents, racial and ethnic minority residents receive care in facilities with more limited financial resources and quality deficiencies. No one has previously examined the role of facility, particularly the percentage of racial and ethnic minority residents at a given facility, and its relationship with anticoagulation use in residents with elevated risks for stroke and AF.

Considering theory‐based structural racism, we measured the association of resident race and ethnicity combined with facility percentage of racial and ethnic minority residents on the use of anticoagulation in US LTC facilities.