Abstract
BackgroundRacial/ethnic disparities in the use of opioids to treat pain disorders have been previously reported in the emergency department (ED). Further research is needed to better evaluate the impact race/ethnicity may have on the use of opioids in adolescents for the management of pain disorders in the ED.MethodsThis was a cross-sectional study using data from the National Hospital Ambulatory Medical Care Survey from 2006 to 2016. Multivariate models were used to evaluate the role of race/ethnicity in the receipt of opioid agonists while in the ED. All ED visits with patients aged 11–21 years old were analyzed. Races/ethnicities were stratified as non-Hispanic Whites, non-Hispanic Blacks, and Hispanics. In addition to race, statistical analysis included the following covariates: pain score, pain diagnosis, age, region, sex, and payment method.ResultsThere was a weighted total of 189,256,419 ED visits. Those visits involved 109,826,315 (58%) non-Hispanic Whites, 46,314,977 (24%) non-Hispanic Blacks, and 33,115,127 (18%) Hispanics, with 21.6% (95% CI, 21.1%-22.1), 15.2% (95% CI, 14.6–15.9%), and 17.4% (95% CI, 16.5–18.2%) of those visits reporting use of opioids, respectively. Regardless of age, sex, and region, non-Hispanic Whites received opioids at a higher rate than non-Hispanic Blacks and Hispanics. Based on diagnosis, non-Hispanic Whites received opioids at a higher rate in multiple pain diagnoses. Additionally, non-Hispanic Blacks and Hispanics were less likely to receive an opioid when reporting moderate pain (aOR = 0.738, 95% CI 0.601–0.906, aOR = 0.739, 95% CI 0.578–0.945, respectively) and severe pain (aOR = 0.580, 95% CI 0.500–0.672, aOR = 0.807, 95% CI 0.685–0.951, respectively) compared to non-Hispanic Whites.ConclusionsDifferences in the receipt of opioid agonists in EDs among the races/ethnicities exist, with more non-Hispanic Whites receiving opioids than their minority counterparts. Non-Hispanic Black women may be an especially marginalized population. Further investigation into sex-based and regional differences are needed.
Highlights
Racial/ethnic disparities in the use of opioids to treat pain disorders have been previously reported in the emergency department (ED)
Patient characteristics and overall trend From 2006 through 2016 there was a weighted total of 189,256,419 ED visits involving patients aged 11–21 years at the time of visit with a reported race/ethnicity of non-Hispanic Black, non-Hispanic White, or Hispanic
Those visits involved 46,314,977 (24%) nonHispanic Black, 33,115,127 (18%) Hispanic, and 109,826, 315 (58%) non-Hispanic White patients, with 15.2%, 17.4%, and 21.6% of those visits associated with receipt of an opioid, respectively (Table 1)
Summary
Racial/ethnic disparities in the use of opioids to treat pain disorders have been previously reported in the emergency department (ED). Further research is needed to better evaluate the impact race/ethnicity may have on the use of opioids in adolescents for the management of pain disorders in the ED. In the emergency department (ED), Non-Hispanic Blacks and Hispanics wait significantly longer to receive care [2,3,4], have lower hospital admission rates [5], receive less diagnostic testing to evaluate chest pain [6], and receive fewer opioids to treat pain than NonHospanic Whites [7,8,9]. Studies have demonstrated that racial minorities, nonHispanic Blacks, report more pain than non-Hispanic Whites, while simultaneously receiving fewer opioid agonists during those visits [14, 15]. Opioid use has come under increased scrutiny in this population, resulting in decreased use in pediatrics within the ED. [3, 18]
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