Racial Disparities in Opioid Analgesia Administration Among Adult Emergency Department Patients with Abdominal Pain

Overview

Journal West J Emerg Med

Specialty Emergency Medicine

Date 2022 Nov 21

PMID 36409944

Authors

Angela F Jarman

Alexander C Hwang

Julia P Schleimer

Roderick W Fontenette

Bryn E Mumma

Affiliations

Soon will be listed here.

Abstract

Introduction: Racial disparities in pain management have been reported among emergency department (ED) patients. In this study we evaluated the association between patients' self-identified race/ethnicity and the administration of opioid analgesia among ED patients with abdominal pain, the most common chief complaint for ED presentations in the United States.

Methods: This was a retrospective cohort study of adult (age ≥18 years) patients who presented to the ED of a single center with abdominal pain from January 1, 2019-December 31, 2020. We collected demographic and clinical information, including patients' race and ethnicity, from the electronic health record. The primary outcome was the ED administration of any opioid analgesic (binary). Secondary outcomes included the administration of non-opioid analgesia (binary) and administration of any analgesia (binary). We used logistic regression models to estimate odds ratios (OR) of the association between a patient's race/ethnicity and analgesia administration. Covariates included age, sex, initial pain score, Emergency Severity Index, and ED visits in the prior 30 days. Subgroup analyses were performed in non-pregnant patients, those who underwent any imaging study, were admitted to the hospital, and who underwent surgery within 24 hours of ED arrival.

Results: We studied 7,367 patients: 45% (3,314) were non-Hispanic (NH) White; 28% (2,092) were Hispanic/Latinx; 19% (1,384) were NH Black, and 8% (577) were Asian. Overall, 44% (3,207) of patients received opioid analgesia. In multivariable regression models, non-White patients were less likely to receive opioid analgesia compared with White patients (OR 0.73, 95% CI 0.65-0.83 for Hispanic/Latinx patients; OR 0.62, 95% CI 0.54-0.72 for Black patients; and OR 0.64, 95% CI 0.52-0.78 for Asian patients). Black patients were also less likely to receive non-opioid analgesia, and Black and Hispanic/Latinx patients were less likely than White patients to receive any analgesia. The associations were similar across subgroups; however, the association was attenuated among patients who underwent surgery within 24 hours of ED arrival.

Conclusion: Hispanic/Latinx, Black, and Asian patients were significantly less likely to receive opioid analgesia than White patients when presenting to the ED with abdominal pain. Black patients were also less likely than White patients to receive non-opioid analgesia.

Citing Articles

Analgesia Administration by Sex Among Pediatric Emergency Department Patients with Abdominal Pain.

Vastola M, Mumma B, Fine J, Tancredi D, Elder J, Jarman A JEM Rep. 2024; 3(1).

PMID: 38435028 PMC: 10906997. DOI: 10.1016/j.jemrpt.2023.100062.

References

Mills A, Shofer F, Boulis A, Holena D, Abbuhl S . Racial disparity in analgesic treatment for ED patients with abdominal or back pain. Am J Emerg Med. 2010; 29(7):752-6. DOI: 10.1016/j.ajem.2010.02.023. View

Cintron A, Morrison R . Pain and ethnicity in the United States: A systematic review. J Palliat Med. 2006; 9(6):1454-73. DOI: 10.1089/jpm.2006.9.1454. View

Shah A, Zogg C, Zafar S, Schneider E, Cooper L, Chapital A . Analgesic Access for Acute Abdominal Pain in the Emergency Department Among Racial/Ethnic Minority Patients: A Nationwide Examination. Med Care. 2015; 53(12):1000-9. DOI: 10.1097/MLR.0000000000000444. View

Dickason R, Chauhan V, Mor A, Ibler E, Kuehnle S, Mahoney D . Racial differences in opiate administration for pain relief at an academic emergency department. West J Emerg Med. 2015; 16(3):372-80. PMC: 4427206. DOI: 10.5811/westjem.2015.3.23893. View

Infinger A, Studnek J . An assessment of pain management among patients presenting to emergency medical services after suffering a fall. Prehosp Disaster Med. 2014; 29(4):344-9. DOI: 10.1017/S1049023X14000594. View

Falch C, Vicente D, Haberle H, Kirschniak A, Muller S, Nissan A . Treatment of acute abdominal pain in the emergency room: a systematic review of the literature. Eur J Pain. 2014; 18(7):902-13. DOI: 10.1002/j.1532-2149.2014.00456.x. View

Young M, Hern H, Alter H, Barger J, Vahidnia F . Racial differences in receiving morphine among prehospital patients with blunt trauma. J Emerg Med. 2013; 45(1):46-52. DOI: 10.1016/j.jemermed.2012.07.088. View

Landry A, Brown I, Blomkalns A, Wolfe R . The role of an academic emergency department in advancing equity and justice. Acad Emerg Med. 2020; 28(9):1087-1090. DOI: 10.1111/acem.14164. View

Shabbir J, Ridgway P, Lynch K, Law C, Evoy D, OMahony J . Administration of analgesia for acute abdominal pain sufferers in the accident and emergency setting. Eur J Emerg Med. 2004; 11(6):309-12. DOI: 10.1097/00063110-200412000-00002. View

10.

Brown T, Shetty A, Zhao D, Harvey N, Yu T, Murphy M . Association between pain control and patient satisfaction outcomes in the emergency department setting. Emerg Med Australas. 2018; 30(4):523-529. DOI: 10.1111/1742-6723.12945. View

11.

Hooker E, Mallow P, Oglesby M . Characteristics and Trends of Emergency Department Visits in the United States (2010-2014). J Emerg Med. 2019; 56(3):344-351. DOI: 10.1016/j.jemermed.2018.12.025. View

12.

Trent S, George N, Havranek E, Ginde A, Haukoos J . Established evidence-based treatment guidelines help mitigate disparities in quality of emergency care. Acad Emerg Med. 2021; 28(9):1051-1060. PMC: 8455068. DOI: 10.1111/acem.14235. View

13.

Lee P, Le Saux M, Siegel R, Goyal M, Chen C, Ma Y . Racial and ethnic disparities in the management of acute pain in US emergency departments: Meta-analysis and systematic review. Am J Emerg Med. 2019; 37(9):1770-1777. DOI: 10.1016/j.ajem.2019.06.014. View

14.

Fosnocht D, Swanson E, Barton E . Changing attitudes about pain and pain control in emergency medicine. Emerg Med Clin North Am. 2005; 23(2):297-306. DOI: 10.1016/j.emc.2004.12.003. View

15.

Huded C, Johnson M, Kravitz K, Menon V, Abdallah M, Gullett T . 4-Step Protocol for Disparities in STEMI Care and Outcomes in Women. J Am Coll Cardiol. 2018; 71(19):2122-2132. DOI: 10.1016/j.jacc.2018.02.039. View

16.

Green C, Anderson K, Baker T, Campbell L, Decker S, Fillingim R . The unequal burden of pain: confronting racial and ethnic disparities in pain. Pain Med. 2003; 4(3):277-94. DOI: 10.1046/j.1526-4637.2003.03034.x. View

17.

Thomas S, Silen W, Cheema F, Reisner A, Aman S, Goldstein J . Effects of morphine analgesia on diagnostic accuracy in Emergency Department patients with abdominal pain: a prospective, randomized trial. J Am Coll Surg. 2003; 196(1):18-31. DOI: 10.1016/s1072-7515(02)01480-1. View

18.

Manterola C, Vial M, Moraga J, Astudillo P . Analgesia in patients with acute abdominal pain. Cochrane Database Syst Rev. 2011; (1):CD005660. DOI: 10.1002/14651858.CD005660.pub3. View