Racial and ethnic disparities in emergency department analgesic prescription

Abstract

Objectives: We examined racial and ethnic disparities in analgesic prescription among a national sample of emergency department patients.

Methods: We analyzed Black, Latino, and White patients in the 1997-1999 National Hospital Ambulatory Medical Care Surveys to compare prescription of any analgesics and opioid analgesics by race/ethnicity.

Results: For any analgesic, no association was found between race and prescription; opioids, however, were less likely to be prescribed to Blacks than to Whites with migraines and back pain, though race was not significant for patients with long bone fracture. Differences in opioid use between Latinos and Whites with the same conditions were less and nonsignificant.

Conclusions: Physicians were less likely to prescribe opioids to Blacks; this disparity appears greatest for conditions with fewer objective findings (e.g., migraine).

FIGURE 1—

Adjusted proportions of patients who received an opioid analgesic, for all patients in National Hospital Ambulatory Medical Care Survey combined and for those presenting with migraine, back pain, and long bone fracture. Note. Whites = black bar; Blacks = dark gray bar; Latinos = light gray bar. All logistic regressions adjust for the covariates of socioeconomic status (SES)/demographics (assessed by sex, age, and method of payment), severity (assessed by triage assignment and pain assessment), visit characteristics (assessed by mode of arrival and discharge status), and hospital characteristics (assessed by hospital ownership, region, urban vs rural, and year of visit).… ^a A conditional logistic or fixed effects logistic regression was done for the entire population; therefore, the estimates are based on comparisons being made only among patients with the same 3 diagnoses by ICD-9 codes.