Differences in Chronic Pain Care among Veterans from Differing Racial and Ethnic Groups: Primary Care, Pain Clinic, Physical Therapy and Emergency/urgent Care Visits

Abstract

An abundance of research provides evidence for racial and ethnic minorities receiving less effective chronic pain treatment. As chronic pain disproportionately impacts US Military Veterans and has substantial physical, psychological, and societal consequences, the purpose of the current study was to identify differences in chronic pain care for African Americans, Asian Americans, and Hispanics, compared to Whites in the Veterans Health Administration. A chronic pain cohort was examined (N = 2,135,216) using VA administrative data from 2018. For each health care utilization variable, multivariate log binomial regression models compared differences between racial/ethnic groups and interactions with rural/urban residence. Additionally, an a priori definition of clinical significance was established due to the large sample size. Clinical significance was achieved if the aRR point estimate was < 0.91 or > 1.10 and was statistically significant. The current study found no differences in pain-related primary care visits among all racial/ethnic groups but did find that African Americans and Asian Americans were less likely to visit pain clinics. Rurality further decreased the likelihood of African Americans receiving pain clinic visits. African Americans were most likely to have pain-related physical therapy visits (aRR = 1.17, 95% CI: 1.16-1.18), followed by Hispanics (aRR = 1.10, 95% CI: 1.08-1.11), relative to Whites. However, this did not hold true with rural Hispanics (aRR = 0.97, 95% CI: 0.92-1.02). For emergency or urgent care visits, African Americans and Hispanics were both more likely to have chronic pain-related visits (aRR = 1.32 and 1.10). All interactions concerning rurality and emergency and urgent care were significant except for rural Hispanics who were less likely to receive emergency room or urgent care visits. The findings from the current study may be useful in further improving the Stepped Care Model of Pain Care to address differences in pain clinic and emergency/urgent care visits. Grant support from the Office of Rural Health grant #16023.