Examining Racial, Ethnic, and Gender Disparities in the Treatment of Pain and Injury Emergencies

Wimbish, Laurel A; Simpson, Janelle R; Gilbert, Lauren; Blackwood, Andria; Grant, Emily A

doi:10.36518/2689-0216.1425

Cited by 4 publications

(15 citation statements)

References 14 publications

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“…The 13 included studies were conducted in ambulance services in multiple countries: USA (n = 5), [37][38][39][40][41] Australia (n = 3), [42][43][44] England (n = 1), 45 Italy (n = 1), 46 South Africa (n = 1), 47 Switzerland (n = 1) 48 and Sweden (n = 1). 49 All but one of the articles, 49 were conducted retrospectively, analysing data that had been routinely collected by an ambulance service as part of patient management.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…All the included studies analysed paramedic analgesic practices, with eight articles specifically investigating sex as a primary outcome. [38][39][40][41][42][43]45,48 Study results are listed in Table 1.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Seven of the studies indicated some form of sex disparity in the administration of analgesia. 37,38,[40][41][42][43][44] This disparity was predominantly in favour of males, with females having a significantly higher risk of oligo-analgesia. That is, females are statistically less likely to receive analgesia, specifically opioids in majority of these studies, in comparison to their male counterparts.…”

Section: Summary Of the Studiesmentioning

confidence: 99%

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Influence of patient sex on pain management practices in Paramedicine: A rapid review

Dahoud,

Simpson,

Naidoo

2024

Paramedicine

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Objective: Pain is a subjective multidimensional experience that impacts an individual's physical, emotional, and mental wellbeing. Paramedics are regularly contacted to alleviate pain, in both an emergency and non-emergency capacity. Patient presentation, assessment tools, and clinical judgement, together influence paramedic decision making, and therefore pain management practices will inevitably vary. This research aimed to identify the nature and description of sex-specific discrepancies in the literature in relation to paramedic pain management. Methods: Using the Cochrane rapid review methodology, a search of five electronic databases and nine paramedic-specific journals was conducted on 8 November 2023. Articles were included if they: investigated ambulance presentations of pain; analysed pharmacological analgesic management; compared management between the sexes; and reported on either medication type, dosage, time to administration, or pain score. Eligible articles were assessed for risk of bias and subjected to narrative synthesis. Results: A total of 2545 articles were identified during the systematic search, resulting in 13 studies eligible for inclusion. Seven studies indicated a sex disparity in the administration of analgesia after controlling for confounders, with females statistically less likely to receive analgesia, particularly opioids, compared to males. Five studies found that sex had no effect on analgesic administration. One study noted female paramedics provided better analgesia overall, while two studies found paramedic sex had no influence on analgesic decisions. Five studies indicated that the higher the pain score, the greater the likelihood of analgesic administration, with three studies highlighting that the analgesia provided was effective in reducing pain score. Conclusions: While some studies identified no sex-specific differences in relation to paramedic pain management, a greater number of studies indicated a gender-disparity, where females were found to have higher risk of oligo-analgesia. Ideal pain management practices were demonstrated in the literature, with higher pain scores correlating to increased rates of analgesia.

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Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Summary Of the Studiesmentioning

confidence: 99%

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Influence of patient sex on pain management practices in Paramedicine: A rapid review

Dahoud,

Simpson,

Naidoo

2024

Paramedicine

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“…Recent guidelines for pain management of traumatic injuries set forth by an expert panel enumerate 4 strong recommendations: (1) assess pain as part of general patient care, (2) consider all patients with acute traumatic pain to be candidates for analgesia, regardless of transport time, (3) use narcotic analgesia for moderate to severe pain, and (4) reassess patients and monitor for adverse effects . Despite the importance of prehospital pain management and known disparities by race and ethnicity in the hospital setting, most studies continue to demonstrate inequities in prehospital pain medication administration …”

Section: Introductionmentioning

confidence: 99%

“…20 Despite the importance of prehospital pain management and known disparities by race and ethnicity in the hospital setting, most studies continue to demonstrate inequities in prehospital pain medication administration. [21][22][23][24][25][26][27][28][29][30] Prior studies using NEMSIS data did not have the advantage of a pain score variable. To gain a snapshot of the entire US and how its agencies administer medications, we used the newly available pain score field and the robust size of the data set to expand on prior research previously limited to smaller cohorts or individual agencies.…”

Section: Introductionmentioning

confidence: 99%

Race and Ethnicity and Prehospital Use of Opioid or Ketamine Analgesia in Acute Traumatic Injury

Brunson,

Miller,

Matheson

et al. 2023

JAMA Netw Open

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ImportanceRacial and ethnic disparities in pain management have been characterized in many hospital-based settings. Painful traumatic injuries are a common reason for 911 activations of the EMS (emergency medical services) system.ObjectiveTo evaluate whether, among patients treated by EMS with traumatic injuries, race and ethnicity are associated with either disparate recording of pain scores or disparate administration of analgesia when a high pain score is recorded.Design, Settings, and ParticipantsThis cohort study included interactions from 2019 to 2021 for US patients ages 14 to 99 years who had experienced painful acute traumatic injuries and were treated and transported by an advanced life support unit following the activation of the 911 EMS system. The data were analyzed in January 2023.ExposuresAcute painful traumatic injuries including burns.Main Outcomes and MeasuresOutcomes were the recording of a pain score and the administration of a nonoral opioid or ketamine.ResultsThe study cohort included 4 781 396 EMS activations for acute traumatic injury, with a median (IQR) patient age of 59 (35-78) years (2 497 053 female [52.2%]; 31 266 American Indian or Alaskan Native [0.7%]; 59 713 Asian [1.2%]; 742 931 Black [15.5%], 411 934 Hispanic or Latino [8.6%], 10 747 Native Hawaiian or other Pacific Islander [0.2%]; 2 764 499 White [57.8%]; 16 161 multiple races [0.3%]). The analysis showed that race and ethnicity was associated with the likelihood of having a pain score recorded. Compared with White patients, American Indian and Alaskan Native patients had the lowest adjusted odds ratio (AOR) of having a pain score recorded (AOR, 0.74; 95% CI, 0.71-0.76). Among patients for whom a high pain score was recorded (between 7 and 10 out of 10), Black patients were about half as likely to receive opioid or ketamine analgesia as White patients (AOR, 0.53; 95% CI, 0.52-0.54) despite having a pain score recorded almost as frequently as White patients.Conclusions and RelevanceIn this nationwide study of patients treated by EMS for acute traumatic injuries, patients from racial or ethnic minority groups were less likely to have a pain score recorded, with Native American and Alaskan Natives the least likely to have a pain score recorded. Among patients with a high pain score, patients from racial and ethnic minority groups were also significantly less likely to receive opioid or ketamine analgesia treatment, with Black patients having the lowest adjusted odds of receiving these treatments.

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Racial and Ethnic Differences in Receipt of Nonpharmacologic Care for Chronic Low Back Pain Among Medicare Beneficiaries With OUD

Bhondoekhan,

Marshall,

Shireman

et al. 2023

JAMA Netw Open

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ImportanceNonpharmacologic treatments are important for managing chronic pain among persons with opioid use disorder (OUD), for whom opioid and other pharmacologic therapies may be particularly harmful. Racial and ethnic minority individuals with chronic pain and OUD are vulnerable to suboptimal pain management due to systemic inequities and structural racism, highlighting the need to understand their receipt of guideline-recommended nonpharmacologic pain therapies, including physical therapy (PT) and chiropractic care.ObjectiveTo assess differences across racial and ethnic groups in receipt of PT or chiropractic care for chronic low back pain (CLBP) among persons with comorbid OUD.Design, Setting, and ParticipantsThis retrospective cohort study used a 20% random sample of national Medicare administrative data from January 1, 2016, to December 31, 2018, to identify fee-for-service community-dwelling beneficiaries with a new episode of CLBP and comorbid OUD. Data were analyzed from March 1, 2022, to July 30, 2023.ExposuresRace and ethnicity as a social construct, categorized as American Indian or Alaska Native, Asian or Pacific Islander, Black or African American, Hispanic, non-Hispanic White, and unknown or other.Main Outcomes and MeasuresThe main outcomes were receipt of PT or chiropractic care within 3 months of CLBP diagnosis. The time (in days) to receiving these treatments was also assessed.ResultsAmong 69 362 Medicare beneficiaries analyzed, the median age was 60.0 years (IQR, 51.5-68.7 years) and 42 042 (60.6%) were female. A total of 745 beneficiaries (1.1%) were American Indian or Alaska Native; 444 (0.6%), Asian or Pacific Islander; 9822 (14.2%), Black or African American; 4124 (5.9%), Hispanic; 53 377 (77.0%); non-Hispanic White; and 850 (1.2%), other or unknown race. Of all beneficiaries, 7104 (10.2%) received any PT or chiropractic care 3 months after a new CLBP episode. After adjustment, Black or African American (adjusted odds ratio, 0.46; 95% CI, 0.39-0.55) and Hispanic (adjusted odds ratio, 0.54; 95% CI, 0.43-0.67) persons had lower odds of receiving chiropractic care within 3 months of CLBP diagnosis compared with non-Hispanic White persons. Median time to chiropractic care was longest for American Indian or Alaska Native (median, 8.5 days [IQR, 0-44.0 days]) and Black or African American (median, 7.0 days [IQR, 0-42.0 days]) persons and shortest for Asian or Pacific Islander persons (median, 0 days [IQR, 0-6.0 days]). No significant racial and ethnic differences were observed for PT.Conclusions and RelevanceIn this retrospective cohort study of Medicare beneficiaries with comorbid CLBP and OUD, receipt of PT and chiropractic care was low overall and lower across most racial and ethnic minority groups compared with non-Hispanic White persons. The findings underscore the need to address inequities in guideline-concordant pain management, particularly among Black or African American and Hispanic persons with OUD.

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Examining Racial, Ethnic, and Gender Disparities in the Treatment of Pain and Injury Emergencies

Cited by 4 publications

References 14 publications

Influence of patient sex on pain management practices in Paramedicine: A rapid review

Influence of patient sex on pain management practices in Paramedicine: A rapid review

Race and Ethnicity and Prehospital Use of Opioid or Ketamine Analgesia in Acute Traumatic Injury

Racial and Ethnic Differences in Receipt of Nonpharmacologic Care for Chronic Low Back Pain Among Medicare Beneficiaries With OUD

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