(224) Education status is not associated with opioid medication receipt among African American emergency department patients with acute pain

Abstract

Inadequate pain treatment in U.S. emergency departments (ED) is common, in part because of the limited and idiosyncratic use of opioids by emergency providers. In a previous study of European Americans (EA, n=690) experiencing acute musculoskeletal pain (MSP) after motor vehicle collision,1 we found a strong inverse relationship between educational status and receipt of opioid medication in the ED. In this study, we repeated the same analysis in a sister cohort of African Americans (AA). Data for this analysis were obtained from an ongoing, prospective cohort study of African Americans (current n=691) who presented to the ED within 24 hours of motor vehicle collision and were discharged to home after evaluation. Patients with long bone fracture were excluded. Consistent with findings in our European American cohort, the majority of study participants in our ongoing African American study had moderate or severe pain (636/691 [92%]), and more educated patients reported lower levels of pain (p<0.001). However, the strong inverse relationship between educational attainment and opioid administration observed in European Americans was absent in the African American cohort. Although frequency of opioid administration was lower among patients with postgraduate educations (7/26 [27%] of AA, 9/87 [10%] of EA) compared to patients who did not complete high school (21/59 [36%] of AA, 15/28 [54%] of EA), opioid receipt did not differ significantly across educational attainment strata (χ2 test p=0.757). When educational attainment, age, sex, acute pain severity in the ED, and income were included as independent variables in a logistic regression model assessing opioid receipt, pain severity was the only significant predictor (p=0.002). Further studies are needed to better understand racial/ethnic differences in the relationship between patient educational attainment and receipt of opioid medication. (1. Platts-Mills, et al., PAIN, 2012.) Supported by NIAMS R01AR060852.