Trends in Opioid Prescribing by Race/Ethnicity for Patients Seeking Care in US Emergency Departments

Pletcher, Mark J.; Kertesz, Stefan G.; Kohn, Michael A.; Gonzales, Ralph

doi:10.1001/jama.2007.64

Cited by 731 publications

(620 citation statements)

References 39 publications

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“…Consistent with prior studies, 2,4 we found that black patients were prescribed opioids less frequently than white patients for moderate to severe pain in the emergency setting. This relationship remained consistent across each aspect of neighborhood-level SES, while accounting for other factors including pain level, type of visit, age, gender, frequency of prior ED visits, and hospital location.…”

Section: Discussionsupporting

confidence: 90%

“…Based on prior literature, we included patient race, ethnicity, gender, patient age, pain severity, region of country, hospital location (urban/ Metropolitan Statistical Areas (MSA)), hospital ownership, and whether the visit was related to an injury or trauma in our models. 2,4 To control for whether a patient was a frequent visitor to the ED, we also included the frequency of prior visits to the ED within the past year and whether the patient had been seen in the ED within the past 72 hours. All covariates were included based clinical significance and statistical significance in bivariate analyses.…”

Section: Discussionmentioning

confidence: 99%

“…23 We also found that prescribing patterns varied according to geographic region, consistent with the previous litera- ture. 2,4 Opioids were prescribed more frequently at ED visits in the South and West regions as compared to the Northeast. According to the most recent US Census data, however, Southern and Midwest states had lower per capita incomes as compared to states in the Northeast.…”

Section: Discussionmentioning

confidence: 99%

“…1 Several studies have consistently documented disparities in opioid prescribing in the emergency department (ED) based on race and ethnicity. [2][3][4][5][6][7] For instance, one study demonstrated that Hispanic patients were twice as likely as non-Hispanic white patients to receive no analgesia for isolated bone fractures in EDs. 5 Further, a recent study demonstrated that the prescribing gap in opioid prescribing by race and ethnicity did not diminish between 1993 and 2005.…”

Section: Introductionmentioning

confidence: 99%

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The Impact of Neighborhood Socioeconomic Status and Race on the Prescribing of Opioids in Emergency Departments Throughout the United States

et al. 2013

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BACKGROUND: Racial and ethnic disparities in opioid prescribing in the emergency department (ED) are well described, yet the influence of socioeconomic status (SES) remains unclear. OBJECTIVES: (1) To examine the effect of neighborhood SES on the prescribing of opioids for moderate to severe pain; and (2) to determine if racial disparities in opioid prescribing persist after accounting for SES. DESIGN: We used cross-sectional data from the National Hospital Ambulatory Medical Care Survey between 2006 and 2009 to examine the prescribing of opioids to patients presenting with moderate to severe pain (184 million visits). We used logistic regression to examine the association between the prescribing of opioids, SES, and race. Models were adjusted for age, sex, pain-level, injury-status, frequency of emergency visits, hospital type, and region. MAIN MEASURES: Our primary outcome measure was whether an opioid was prescribed during a visit for moderate to severe pain. SES was determined based on income, percent poverty, and educational level within a patient's zip code. RESULTS: Opioids were prescribed more frequently at visits from patients of the highest SES quartile compared to patients in the lowest quartile, including percent poverty (49.0 % vs. 39.4 %, P<0.001), household income (47.3 % vs. 40.7 %, P < 0.001), and educational level (46.3 % vs. 42.5 %, P=0.01). Black patients were prescribed opioids less frequently than white patients across all measures of SES. In adjusted models, black patients (AOR 0.73; 95 % CI 0.66-0.81) and patients from poorer areas (AOR 0.76; 95 % CI 0.68-0.86) were less likely to receive opioids after accounting for pain-level, age, injury-status, and other covariates. CONCLUSIONS: Patients presenting to emergency departments from lower SES regions were less likely to receive opioids for equivalent levels of pain than those from more affluent areas. Black and Hispanic patients were also less likely to receive opioids for equivalent levels of pain than whites, independent of SES.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Impact of Neighborhood Socioeconomic Status and Race on the Prescribing of Opioids in Emergency Departments Throughout the United States

et al. 2013

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“…Community-informed solutions to racial disparities and infant mortality are necessary because, despite the significance of the adverse outcome (i.e., infant mortality and persistent racial disparities in birth outcomes) [16-18, 26, 27] and the persistent conditions that contribute to poor outcomes [4,5,11,[28][29][30][31], much of the literature is problem focused. Medical treatment and prevention strategies tend to be narrowly focused, failing to take into account the complex nature of racism [32][33][34][35]. Byrd et al, for example, concluded that improving both prenatal care and maternal education attainment in Wisconsin would decrease infant mortality rates; however, these strategies would be unlikely to eliminate the black-white disparity in infant mortality and had the potential to widen the black-white gap [36].…”

Section: Introductionmentioning

confidence: 99%

Application of a Mixed Methods Approach to Identify Community-Level Solutions to Decrease Racial Disparities in Infant Mortality

Kasehagen¹,

Brandert²,

Nickol³

et al. 2014

J. Racial and Ethnic Health Disparities

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Objectives This study aimed to identify community-level actions to decrease racial disparities in infant mortality (IM). Design Six urban multidisciplinary teams generated ideas for decreasing racial disparities in IM using a mixed methods concept mapping approach. Participants rated each idea as to its necessity and action potential and grouped ideas by theme. A cluster analysis produced a series of visual representations, showing relationships between the identified actions and the clustering of actions into themes. Multidimensional scaling techniques were used to produce analyses describing the necessity of and action potential for implementing the proposed ideas. Participants identified actions communities could take to decrease racial disparities in IM and suggested applications of the knowledge gained from the mapping process. Results Participants produced a total of 128 actions, within 11 thematic clusters, for decreasing racial disparities in IM. The thematic clusters contained a range of elements designed to promote knowledge and understanding of the relationship between health and racism; improve educational systems and community opportunities; facilitate community-driven health promotion, marketing, and research; improve health services -014-0008-4 for women; address physical and social environments that impact community health; prioritize resource allocation of community-based services; institutionalize strategies that promote equity across all systems; and create and support legislation and policies that address social determinants of health. Correlation coefficients of the clusters ranged from 0.17 to 0.90. Average necessity ratings ranged from 2.17 to 3.73; average action potential ratings ranged from 1.64 to 3.61. Conclusion Findings suggest that thematic clusters with high action potential usually represented ongoing community activities or actions communities could easily initiate. Community size, existing programs, partnerships, policies, and influential advocates were among the factors cited affecting feasibility of implementation. Clusters with lower action potential require broader, longer term, policy, institutional or systemwide changes, and significant resources. High necessity clusters often contained actions perceived as essential for change, but sometimes outside of a community's control. Participants identified a number of practical actions that were considered to hold potential for individual, community, and institutional changes which could result in decreasing racial disparities in IM.. Racial and Ethnic Health Disparities (2014) 1:69-84 DOI 10.1007/s40615

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Cranial Computed Tomography Use Among Children With Minor Blunt Head Trauma

Natale

Joseph

Rogers

et al. 2012

Arch Pediatr Adolesc Med

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Objective: To determine if patient race/ethnicity is independently associated with cranial computed tomography (CT) use among children with minor blunt head trauma.Design: Secondary analysis of a prospective cohort study.Setting: Pediatric research network of 25 North American emergency departments.Patients: In total, 42 412 children younger than 18 years were seen within 24 hours of minor blunt head trauma. Of these, 39 717 were of documented white non-Hispanic, black non-Hispanic, or Hispanic race/ethnicity. Using a previously validated clinical prediction rule, we classified each child's risk for clinically important traumatic brain injury to describe injury severity. Because no meaningful differences in cranial CT rates were observed between children of black non-Hispanic race/ethnicity vs Hispanic race/ethnicity, we combined these 2 groups.Main Outcome Measure: Cranial CT use in the emergency department, stratified by race/ethnicity.Results: In total, 13 793 children (34.7%) underwent cranial CT. The odds of undergoing cranial CT among children with minor blunt head trauma who were at higher risk for clinically important traumatic brain injury did not differ by race/ethnicity. In adjusted analyses, children of black non-Hispanic or Hispanic race/ethnicity had lower odds of undergoing cranial CT among those who were at intermediate risk (odds ratio, 0.86; 95% CI, 0.78-0.96) or lowest risk (odds ratio, 0.72; 95% CI, 0.65-0.80) for clinically important traumatic brain injury. Regardless of risk for clinically important traumatic brain injury, parental anxiety and request was commonly cited by physicians as an important influence for ordering cranial CT in children of white non-Hispanic race/ethnicity.Conclusions: Disparities may arise from the overuse of cranial CT among patients of nonminority races/ ethnicities. Further studies should focus on explaining how medically irrelevant factors, such as patient race/ ethnicity, can affect physician decision making, resulting in exposure of children to unnecessary health care risks.

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Trends in Opioid Prescribing by Race/Ethnicity for Patients Seeking Care in US Emergency Departments

Cited by 731 publications

References 39 publications

The Impact of Neighborhood Socioeconomic Status and Race on the Prescribing of Opioids in Emergency Departments Throughout the United States

The Impact of Neighborhood Socioeconomic Status and Race on the Prescribing of Opioids in Emergency Departments Throughout the United States

Application of a Mixed Methods Approach to Identify Community-Level Solutions to Decrease Racial Disparities in Infant Mortality

Cranial Computed Tomography Use Among Children With Minor Blunt Head Trauma

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