HealthNovember 17, 2015

US emergency departments show racial/ethnic disparities in pain management

Minority patients are less likely to receive analgesic medications for abdominal pain at US emergency departments (EDs), suggests a nationwide study in the December issue of Medical Care. The journal is published by Wolters Kluwer.

"This analysis, which uses data from EDs from across the country, found that minorities experience significant disparities with regard to the receipt of analgesic medications for abdominal pain," comments senior author Dr. Adil H. Haider of Brigham and Women's Hospital, Boston. "Black patients had the greatest increased odds of undertreatment for pain among the groups considered. Black and Hispanic patients experienced prolonged ED lengths of stay and were less likely to be hospitalized for their ailments."

Race/ethnicity and hospital factors affect analgesic use at US EDs

The study included data on more than 6,700 adult patients with nontraumatic acute abdominal pain, seen at 350 US EDs between 2006 and 2010. Drawn from the Centers for Disease Control and Prevention's National Hospital Ambulatory Medical Care Survey, the sample represented more than 25 million visits to 4,700 EDs nationwide.

About 61 percent of the patients were (non-Hispanic) white, 20 percent black, 14 percent Hispanic, and five percent of other racial/ethnic groups. Rates of analgesic (pain-relieving) medication use were compared among racial/ethnic groups; the study also accounted for differences in patient and hospital characteristics.

Overall, white patients were most likely to receive any analgesic medication: 57 percent, compared to 53 percent for Hispanic patients, 51 percent for black patients, and 47 percent for those of other racial/ethnic groups. White patients were more likely to receive narcotic analgesic drugs than black patients, despite similar rates of severe pain.

After adjustment for other factors, patients of minority race/ethnicity were 22 to 30 percent less likely to receive any analgesic medication, and 17 to 30 percent less likely to receive narcotic analgesics (relative to white patients). Minority patients also had longer ED waiting times, were more likely to remain in the ED for a prolonged period, and were less likely to be admitted to the hospital.

On analysis of hospital factors, the discrepancies were concentrated in hospitals that served the largest percentage of minority patients and the largest proportion of patients with severe pain. Black patients at these hospitals were at particularly high risk of inadequate treatment for pain.

Racial/ethnic disparities in care delivery and outcomes are an ongoing issue in the US healthcare system. Discrepancies in emergency care are of special concern, since EDs play a central role as primary care provider for a diverse group of patients.

Dr. Haider adds, "These findings add to the overwhelming evidence that racial/ethnic disparities not only exist, but are unfortunately endemic in health care settings." The researchers call for further studies to clarify the "root causes" of the racial/ethnic differences in pain management. The finding that disparities are higher at EDs that see more minority patients and more cases of severe pain suggest that hospital-level factors contribute to gaps in adequate pain treatment.

"Our findings indicate that disparities in healthcare delivery continue to represent an area of important concern," Dr. Haider and coauthors conclude. "It is essential that we as a medical community work to ensure that every patient receive unbiased empathy and the highest standard of care, regardless of his/her racial heritage."

Click here to read "Analgesic Access for Acute Abdominal Pain in the Emergency Department Among Racial/Ethnic Minority Patients: A Nationwide Examination."

Article: "Analgesic Access for Acute Abdominal Pain in the Emergency Department Among Racial/Ethnic Minority Patients: A Nationwide Examination" (doi: 10.1097/MLR.0000000000000444)

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