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Journal of General Internal Medicine

Erschienen in:

12.09.2023 | Original Research

Trends in Racial Inequalities in the Administration of Opioid and Non-opioid Pain Medication in US Emergency Departments Across 1999–2020

verfasst von: Trevor Thompson, PhD, Sofia Stathi, PhD, Francesca Buckley, MSc, Jae Il Shin, MD PhD, Chih-Sung Liang, MD

Erschienen in: Journal of General Internal Medicine | Ausgabe 2/2024

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Abstract

Background

Despite initiatives to eradicate racial inequalities in pain treatment, there is no clear picture on whether this has translated to changes in clinical practice.

Objective

To determine whether racial disparities in the receipt of pain medication in the emergency department have diminished over a 22-year period from 1999 to 2020.

Design

We used data from the National Hospital Ambulatory Medical Care Survey, an annual, cross-sectional probability sample of visits to emergency departments of non-federal general and short-stay hospitals in the USA.

Patients

Pain-related visits to the ED by Black or White patients.

Main Measures

Prescriptions for opioid and non-opioid analgesics.

Key Results

A total of 203,854 of all sampled 625,433 ED visits (35%) by Black or White patients were pain-related, translating to a population-weighted estimate of over 42 million actual visits to US emergency departments for pain annually across 1999–2020. Relative risk regression found visits by White patients were 1.26 (95% CI, 1.22–1.30; p<0.001) times more likely to result in an opioid prescription for pain compared to Black patients (40% vs. 32%). Visits by Black patients were also 1.25 (95% CI, 1.21–1.30; p<0.001) times more likely to result in non-opioid analgesics only being prescribed. Results were not substantively altered after adjusting for insurance status, type and severity of pain, geographical region, and other potential confounders. Spline regression found no evidence of meaningful change in the magnitude of racial disparities in prescribed pain medication over 22 years.

Conclusions

Initiatives to create equitable healthcare do not appear to have resulted in meaningful alleviation of racial disparities in pain treatment in the emergency department.

Nur mit Berechtigung zugänglich

Sinatra R. Causes and consequences of inadequate management of acute pain. Pain Med. 2010;11:1859-1871. https://doi.org/10.1111/j.1526-4637.2010.00983.x.CrossRefPubMed

Kang H, Zhang P, Lee S, Shen S, Dunham E. Racial disparities in opioid administration and prescribing in the emergency department for pain. Am J Emerg Med. 2022;55:167-173. https://doi.org/10.1016/j.ajem.2022.02.043.CrossRefPubMed

Pletcher MJ, Kertesz SG, Kohn MA, Gonzales R. Trends in opioid prescribing by race/ethnicity for patients seeking care in US emergency departments. JAMA. 2008;299:70-78. https://doi.org/10.1001/jama.2007.64.CrossRefPubMed

Joynt M, Train MK, Robbins BW, Halterman JS, Caiola E, Fortuna RJ. The impact of neighborhood socioeconomic status and race on the prescribing of opioids in emergency departments throughout the United States. J Gen Intern Med. 2013;28:1604-1610. https://doi.org/10.1007/s11606-013-2516-z.CrossRefPubMedPubMedCentral

Shah AA, Zogg CK, Zafar SN, et al. Analgesic access for acute abdominal pain in the emergency department among racial/ethnic minority patients: a nationwide examination. Med Care. 2015;53:1000-1009. doi:https://doi.org/10.1097/MLR.0000000000000444.CrossRefPubMed

Romanelli RJ, Shen Z, Szwerinski N, Scott A, Lockhart S, Pressman AR. Racial and ethnic disparities in opioid prescribing for long bone fractures at discharge from the emergency department: a cross-sectional analysis of 22 centers from a health care delivery system in Northern California. Ann Emerg Med. 2019;74:622-631. https://doi.org/10.1016/j.annemergmed.2019.05.018.CrossRefPubMed

Mills AM, Shofer FS, Boulis AK, Holena DN, Abbuhl SB. Racial Disparity in Analgesic Treatment for ED Patients with Abdominal or Back Pain. Am J Emerg Med. 2011;29:752-756. doi:https://doi.org/10.1016/j.ajem.2010.02.023.

Todd KH, Deaton C, D’Adamo AP, Goe L. Ethnicity and analgesic practice. Ann Emerg Med. 2000;35:11-16. https://doi.org/10.1016/s0196-0644(00)70099-0.CrossRefPubMed

Terrell KM, Hui SL, Castelluccio P, Kroenke K, McGrath RB, Miller DK. Analgesic prescribing for patients who are discharged from an emergency department. Pain Med. 2010;11:1072-1077. https://doi.org/10.1111/j.1526-4637.2010.00884.x.CrossRefPubMed

10.

Heins JK, Heins A, Grammas M, Costello M, Huang K, Mishra S. Disparities in analgesia and opioid prescribing practices for patients with musculoskeletal pain in the emergency department. J Emerg Nurs. 2006;32:219-224. https://doi.org/10.1016/j.jen.2006.01.010.CrossRefPubMed

11.

Dickason RM, Chauhan V, Mor A, et al. Racial differences in opiate administration for pain relief at an academic emergency department. West J Emerg Med. 2015;16:372-380. https://doi.org/10.5811/westjem.2015.3.23893.CrossRefPubMedPubMedCentral

12.

Santoro TN, Santoro JD. Racial bias in the US Opioid epidemic: a review of the history of systemic bias and implications for care. Cureus. 2018;10:e3733. https://doi.org/10.7759/cureus.3733.CrossRef

13.

Morden NE, Chyn D, Wood A, Meara E. Racial inequality in prescription opioid receipt - role of individual health systems. N Engl J Med. 2021;385:342-351. https://doi.org/10.1056/NEJMsa2034159.CrossRef

14.

King NB, Fraser V. Untreated pain, narcotics regulation, and global health ideologies. PLoS Med. 2013;10:e1001411. https://doi.org/10.1371/journal.pmed.1001411.CrossRefPubMedPubMedCentral

15.

Institute Of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington (DC): National Academies Press (US); 2003.https://doi.org/10.17226/12875

16.

Public Law 111 - 148 - Patient Protection and Affordable Care Act. Published 2010. Accessed 5 May, 2023. https://www.govinfo.gov/app/details/PLAW-111publ148.

17.

Centers For Disease Control And Prevention. Estimates of Emergency Department Visits in the United States, 2016-2020. Published December 15, 2022. Accessed 27 April, 2023. https://www.cdc.gov/nchs/dhcs/ed-visits/.

18.

von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 2007;147:573-577. https://doi.org/10.7326/0003-4819-147-8-200710160-00010.CrossRef

19.

McCaig LF, Burt CW. Understanding and interpreting the national hospital ambulatory medical care survey: key questions and answers. Ann Emerg Med. 2012;60:716-721.e1. https://doi.org/10.1016/j.annemergmed.2012.07.010.CrossRefPubMed

20.

National Center For Health Statistics. Survey Instruments. Centers for Disease Control and Prevention. Published 2023. Accessed 4 July, 2023. https://www.cdc.gov/nchs/ahcd/ahcd_survey_instruments.htm

21.

National Center For Health Statistics. 2020 NHAMCS micro-data file documentation. Published 2020. Accessed 5 May, 2023. https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHAMCS/doc20-ed-508.pdf

22.

Centers For Disease Control And Prevention. The Ambulatory Care Drug Database System. Published 2023. Accessed 5 May, 2023. https://www2.cdc.gov/drugs/applicationnav1.asp

23.

National Center For Health Statistics. Datasets and documentation. Centers for Disease Control and Prevention. Published March 23, 2023. Accessed 5 May, 2023. https://www.cdc.gov/nchs/ahcd/datasets_documentation_related.htm

24.

Hastie TJ. Generalized additive models (Chapter 7). In: Chambers JM, T. J. Hastie, eds. Statistical Models. Wadsworth & Brooks/Cole; 1992:201-260

25.

Lumley T. survey: analysis of complex survey samples. R package version 40. 2020

26.

R Core Team. R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2022

27.

Butler MM, Ancona RM, Beauchamp GA, et al. Emergency department prescription opioids as an initial exposure preceding addiction. Ann Emerg Med. 2016;68:202-208. https://doi.org/10.1016/j.annemergmed.2015.11.033.CrossRefPubMedPubMedCentral

28.

National Center For Health Statistics. Notices for NAMCS and NHAMCS Public Use Data File Users. Centers for Disease Control and Prevention. Published March 15, 2023. Accessed 17 May, 2023. https://www.cdc.gov/nchs/ahcd/notice.htm

29.

Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain--United States, 2016. JAMA. 2016;315:1624-1645. https://doi.org/10.1001/jama.2016.1464https://doi.org/10.1111/pme.12907. https://doi.org/10.1097/MLR.0000000000000505.

30.

Humphreys K, Shover CL, Andrews CM, et al. Responding to the opioid crisis in North America and beyond: recommendations of the Stanford-Lancet Commission. Lancet. 2022;399:555-604. https://doi.org/10.1016/S0140-6736(21)02252-2.CrossRef

31.

Campbell LC, Robinson K, Meghani SH, Vallerand A, Schatman M, Sonty N. Challenges and opportunities in pain management disparities research: implications for clinical practice, advocacy, and policy. J Pain. 2012;13:611-619. https://doi.org/10.1016/j.jpain.2012.02.004.CrossRefPubMedPubMedCentral

32.

Meghani SH, Polomano RC, Tait RC, Vallerand AH, Anderson KO, Gallagher RM. Advancing a national agenda to eliminate disparities in pain care: directions for health policy, education, practice, and research. Pain Med. 2012;13:5-28. https://doi.org/10.1111/j.1526-4637.2011.01289.x.CrossRefPubMed

33.

H.R.756 - National Pain Care Policy Act of 2009. Published 2009. Accessed 5 May, 2023. https://www.congress.gov/bill/111th-congress/house-bill/756

34.

Morales ME, Yong RJ. Racial and ethnic disparities in the treatment of chronic pain. Pain Med. 2021;22:75-90. https://doi.org/10.1093/pm/pnaa427.CrossRef

35.

Ly DP. Racial and ethnic disparities in the evaluation and management of pain in the outpatient setting, 2006-2015. Pain Med. 2019;20:223-232. https://doi.org/10.1093/pm/pny074.CrossRef

36.

Han B, Compton WM, Jones CM, Cai R. Nonmedical prescription opioid use and use disorders among adults aged 18 through 64 years in the United States, 2003-2013. JAMA. 2015;314:1468-1478. https://doi.org/10.1001/jama.2015.11859.CrossRef

37.

Simoni-Wastila L, Ritter G, Strickler G. Gender and other factors associated with the nonmedical use of abusable prescription drugs. Subst Use Misuse. 2004;39:1-23. https://doi.org/10.1081/ja-120027764.CrossRefPubMed

38.

Saha S, Beach MC, Cooper LA. Patient centeredness, cultural competence and healthcare quality. J Natl Med Assoc. 2008;100:1275-1285. https://doi.org/10.1016/s0027-9684(15)31505-4.CrossRefPubMed

Titel: Trends in Racial Inequalities in the Administration of Opioid and Non-opioid Pain Medication in US Emergency Departments Across 1999–2020
verfasst von: Trevor Thompson, PhD
Sofia Stathi, PhD
Francesca Buckley, MSc
Jae Il Shin, MD PhD
Chih-Sung Liang, MD
Publikationsdatum: 12.09.2023
Verlag: Springer International Publishing
Erschienen in: Journal of General Internal Medicine / Ausgabe 2/2024
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-023-08401-2

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Abstract

Background

Objective

Design

Patients

Main Measures

Key Results

Conclusions

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